Preoperative quality of life (QOL) at time of gynecologic surgery: considerations for postoperative management

Patients presenting for gynecologic surgery are a heterogeneous group. Preoperative quality of life may be a useful tool to guide postoperative management. The objective of this study was to examine the key drivers of preoperative QOL in order to improve counseling and postoperative management. This study analyzed preoperative survey results from 154 participants using the following surveys: National Institutes of Health Toolbox Global Health v1.2, Gastrointestinal: Gas and Bloating v1.1 13a, Gastrointestinal: Diarrhea v1.0 6a, and Sexual Function and Satisfaction Brief Profile (Female) v2.0, Perceived Stress Scale, the Vaginal Assessment Scale, and the Vulvar Assessment Scale. Survey results in the form of T-scores were compared in patients with endometrial cancer (EMC) and patients with benign gynecologic conditions using the Kruskal-Wallis test. The multivariate analysis was performed using linear regression to adjust the comparisons for age, BMI, and comorbidity. Of the 154 patients, preoperative diagnosis was benign in 66% (N=102) and EMC in 34% (N=52). EMC patients were more likely to be older, non-White, in lower income brackets, higher BMI, and postmenopausal (p<0.05). Although preoperative global health scores were similar between benign and malignant cases (p>0.05), when adjusted for age, the differences in global health QOL between benign and EMC patients became significant, since the EMC group was older than the benign group (p<0.05). However, when adjusting for age, BMI, and comorbidities (hypertension and diabetes), the differences were no longer significant (p>0.05). Sexual interest was decreased in the EMC patients both in the unadjusted and adjusted model, and vulvar complaints became significantly different between the groups when controlling for BMI, age, and comorbidities (p<0.05). Despite substantial differences in preoperative diagnosis, preoperative quality of life is highly influenced by age, BMI, and comorbidities. Thus, these factors should be explored in surgical outcomes and postoperative management trials.