Perioperative morbidity and mortality of gynecologic brachytherapy

The incidence and nature of perioperative complications associated with gynecologic brachytherapy applications were determined in 462 implants performed on 327 patients with cervical, endometrial, or vaginal cancer from 1986 to 1988. Twenty-one patients (6.4%) had life-threatening complications, including cardiac (16 patients), thromboembolic (4 patients), and pulmonary (1 patient) events. Three complications (0.9%) were fatal within the first 30 days, and two patients died of delayed sequelae of perioperative complications; thus, there was an overall 1.5% mortality rate. Patients experiencing life-threatening complications tended to be older (P = 0.0002), and to have a history of cardiac disease (P = 0.0002) and an increased American Society of Anesthesiology (ASA) score (P = 0.003). Logistic analysis demonstrated that a history of cardiac disease and increased age were independent predictors of life-threatening complications (P = 0.01). Careful patient selection and intensive perioperative care of the high-risk patient may prove to substantially diminish these complications.