The effect of polyallergy on ancillary service use among postoperative patients with gynecologic malignancies

To determine if polyallergy (four or more documented allergies in the electronic medical record [EMR]) is an independent predictor of ancillary service use.

Single institution, retrospective cohort study of patients who underwent surgery for gynecologic malignancy between 01/2016 and 05/2024. Demographics, comorbidities, surgical details, postoperative complications, and allergies were abstracted from the EMR. The primary outcome was ancillary service utilization for one year postoperatively including emergency room, psychologic services, primary care, urgent care visits, and hospitalizations. Descriptive statistics, univariate, and multivariate analyses were performed.

398 patients met study criteria and 77 patients had polyallergy with a median of 5 allergies (IQR 4-7). Most patients were White (92%) non-smokers (56%) with a median age of 65 (IQR 37-51). Patients with polyallergy had higher rates of anxiety (38% vs 25%, p = 0.03), depression (45% vs 32%, p = 0.03), panic disorder (6% vs 2%, 0.04), and antipsychotic prescriptions (6% vs 2%, p = 0.03). There were more ancillary service encounters among those with polyallergy compared to non-polyallergy (median 4, IQR 2-6 vs 2 IQR 1-5, p = 0.001). On univariate analysis, polyallergy was significantly associated with ancillary service use (p = 0.002), which remained significant on multivariate analysis (RR = 0.21, CI 0.02-0.39, p = 0.03), as was any psychiatric diagnosis (RR = 0.34, CI 0.19-0.48, p < 0.001), and any postoperative complication (RR = 0.29, CI 0.08-0.50, p = 0.006).

Polyallergy was an independent risk factor for ancillary service use. Patients with polyallergy may benefit from earlier primary care, case management, and possibly psychological intervention in an effort to prevent increased ancillary service use.