Supplementary Table 1 Postoperative complications
Category / DetailsAbscess/Haematoma / Pelvic or abdominal abscess / haematoma
Anastomotic leak / Anastomotic leak: Small bowel
Anastomotic leak: Large bowel
Ileus / Post op ileus requiring nasogastric tube / Total parental nutrition
Bowel obstruction / Bowel Obstruction – small bowel confirmed on imaging
Bowel Obstruction – large bowel confirmed on imaging
Bowel perforation / Small / large bowel
Bowel - other / Constipation / Diarrhoea / Faecal incontinence/urgency
Bladder / Urinary retention requiring catheterisation
Urinary obstruction
Incontinence- stress / urge
Cardiac / Atrial fibrillation, Myocardial infarction, Cardiac failure & other cardiac problems
Deep vein thrombosis / Confirmed on imaging / Doppler
Pulmonary embolism / Confirmed on imaging
Fistula / Enterocutaneous
Enterovaginal
Vesicovaginal
Ureterovaginal
Other types of fistula
Hernia / Hernia as a result of surgery
Infection / Pyrexia (>38.5°C on 2 separate occasions) after 48 hrs post op requiring antibiotics OR infection confirmed by culture
Lymphocyst/Lymphoedema / Lymphoedema
Lymphocyst
Neurological / Neuropathic pain/ paraesthesia / nerve palsy
Psychiatric / Unexpected psychiatric problems postoperatively e.g. Delirium, Psychosis, Depression and other
Primary haemorrhage / Haemorrhage within 24 hrs of surgery requiring transfusion/packing/embolisation/return to theatre/other
Secondary haemorrhage / Haemorrhage after 24 hrs of surgery requiring transfusion/packing/embolisation/return to theatre/other
Respiratory / Pulmonary oedema, Pneumothorax, Atelectasis, Pleural effusion and other respiratory problems excluding pneumonia (to be included in infections)
Ureteric Obstruction / Ureteric obstruction postoperatively
Wound breakdown / Wound breakdown: Superficial - skin & subcutaneous tissue
Wound breakdown: Deep - involving fascia / muscle
Burst abdomen requiring repair under anaesthesia
Other / Other complications not included in the list
Table 2 Sensitivity of hospital and patient-reporting by type of complication
Complication category / Total / No. reported by Hospital / No. reported by PatientNo / (%) / No / (%)
Wound breakdown / 140 / 48 / 34 / 114 / 81
Infection / 126 / 51 / 40 / 86 / 68
Lymphocyst/Lymphoedema / 39 / 9 / 23 / 31 / 79
Bladder / 17 / 13 / 76 / 6 / 35
Ileus / 16 / 13 / 81 / 6 / 38
Abscess/Haematoma / 14 / 8 / 57 / 10 / 71
Bowel - other / 11 / 6 / 55 / 7 / 64
Secondary haemorrhage / 10 / 7 / 70 / 6 / 60
Cardiac / 7 / 6 / 86 / 3 / 43
Bowel obstruction / 7 / 5 / 71 / 3 / 43
Fistula / 7 / 5 / 71 / 5 / 71
Respiratory / 6 / 4 / 67 / 2 / 33
Primary haemorrhage / 5 / 4 / 80 / 4 / 80
Pulmonary Embolism / 5 / 2 / 40 / 3 / 60
Deep Vein Thrombosis / 5 / 1 / 20 / 4 / 80
Neurological / 4 / 2 / 50 / 3 / 75
Hernia / 4 / 0 / 0 / 4 / 100
Anastomotic leak / 2 / 2 / 100 / 2 / 100
Psychiatric / 2 / 1 / 50 / 1 / 50
Bowel perforation / 2 / 1 / 50 / 1 / 50
Ureteric obstruction / 1 / 0 / 0 / 1 / 100
Other / 22 / 12 / 55 / 13 / 59
Total / 452 / 200 / 44 / 315 / 70
Supplementary document 1: Free-text format follow-up letter template
United Kingdom Gynaecological Oncology Surgical Outcomes and Complications (UKGOSOC)
Private and Confidential
Ms «First_Name» «Last_Name»
«Address1»
«Address2»
«Town»
«County»
Date
Dear Ms «Last_Name»,
UKGOSOC Reference number: «UKGOSOC_Ref»
Thank you for participating in this audit.
You might recall your consultant (or one of the members of the team) mentioning that we would be writing to you following your surgery, to find out if you had any problems (complications) relating to your operation.
We would be grateful if you could fill in the tear-off slip at the bottom of this letter and return it to us in the FREE POST envelope provided. We look forward to hearing from you.
Yours sincerely,
(On behalf of the co-ordinating centre team)
If you have any queries, please contact your local hospital on the following phone numbers:
" ------
Supplementary document 2: Questionnaire format follow-up letterA surgical complication may be defined as ‘an undesirable and unintended result of an operation affecting the patient that occurs as a direct result of the operation’.
· Below is a list of 11 common complications experienced by patients.
· Even though the list appears long, it should only take approximately five minutes of your time.
· Please choose the complication/s that is most appropriate and indicate the treatment you required.
· You may choose more than one option.
· However if your complication is not on the list, please use the free text space provided.
· Please use additional paper if necessary.
1 / Did the wound get infected or did it breakdown? / Yes / No
If the answer is yes, how was this treated?
a. Antibiotics / Yes / No
b. Regular dressing of the wound / Yes / No
c. Required re-admission to hospital / Yes / No
d. Cleaning (debridement) in the operating theatre / Yes / No
e. Re-suturing in the operating theatre / Yes / No
f. Other (please give details) / Yes / No
2 / Excluding a wound infection, have you had any other infection following your surgery? / Yes / No
a. Urine infection / Yes / No
b. Chest Infection or Pneumonia / Yes / No
c. Other (please give details) / Yes / No
How was the infection treated?
a. With antibiotics / Yes / No
b. Required re-admission to hospital / Yes / No
c. Required other treatment (please give details) / Yes / No
3 / Did you develop an abscess or a haematoma (collection of blood) in your pelvis or abdomen following surgery? / Yes / No
If so how was this managed
a. Resolved spontaneously / Yes / No
b. Treated with antibiotics / Yes / No
c. Required drainage in the x-ray / radiology department / Yes / No
d. Required drainage in the operating theatre / Yes / No
e. Other (please give details) / Yes / No
4 / Light vaginal bleeding is common after most gynaecological procedures. Have you had heavy vaginal bleeding following surgery? / Yes / No
If so, how was this managed? / Yes / No
a. It settled spontaneously / Yes / No
b. It was treated with antibiotics / Yes / No
c. It required re-admission to hospital / Yes / No
d. It required packing of the vagina / Yes / No
e. It required being taken back to the operating theatre / Yes / No
f. Other (please give details) / Yes / No
5 / Lymphoedema is a build-up of lymph fluid which can occur as a result of lymph nodes being removed at surgery. It is commonly seen in the legs.
Have you had lymphoedema following surgery? / Yes / No
If so, how was this managed? / Yes / No
a. With compression stockings / Yes / No
b. Other (please give details) / Yes / No
6 / Lymphocyst is a collection of lymph fluid which occurs in the area where the lymph node was removed. This usually occurs in the pelvis or in the groin as a result of surgery.
Have you had a lymphocyst following surgery? / Yes / No
If so, how was this managed?
a. It was left to resolve spontaneously / Yes / No
b. It was drained on the ward / clinic / Yes / No
c. Required re-admission to hospital / Yes / No
d. It was removed / drained under general anaesthesia in the operating theatre / Yes / No
e. Other (please give details)
7 / Have you been troubled with constipation after surgery? (please do not fill this if you had this problem before surgery)
If so how was this managed? / Yes / No
a. Diet / Yes / No
b. Laxatives / Yes / No
c. Required re-admission to hospital for treatment / Yes / No
d. Other (please give details) / Yes / No
8 / Have you had any other problems related to your bowels? (please do not fill this if you had this problem before surgery)
If so, please give details / Yes / No
9 / Have you had any problems with your bladder since the surgery (please do not fill this if you had this problem before surgery) / Yes / No
a. Difficulty in emptying the bladder / Yes / No
b. Loss of sensation to empty bladder / Yes / No
c. Leaking with coughing / sneezing / walking etc. (Stress incontinence) / Yes / No
d. An urgent need to pass urine with occasional leakage of urine (urge incontinence) / Yes / No
e. Inability to pass urine requiring insertion of a catheter (urinary retention) / Yes / No
f. Required re-admission to hospital for treatment / Yes / No
g. Other (please give details) / Yes / No
10 / Did you develop a blood clot in your legs (deep vein thrombosis) after surgery?
If so, what sort of treatment did you receive? / Yes / No
a. Daily injections for blood thinning (heparin) / Yes / No
b. Blood thinning tablets (Warfarin) / Yes / No
c. Required re-admission to the hospital for treatment / Yes / No
d. Other (please give details) / Yes / No
11 / Did you develop a clot in the lung (pulmonary embolism) following surgery?
If so, how was this treated? / Yes / No
a. Daily injections for blood thinning (heparin) / Yes / No
b. Blood thinning tablets (Warfarin) / Yes / No
c. Required re-admission to hospital / Yes / No
d. Other (please give details) / Yes / No
12 / If you have had any other complication not listed here, please give details below regarding the nature of the complication, how this was treated and whether you required re-admission into hospital for this. Please use additional paper if necessary. / Yes / No
We would be grateful if you could provide a little more information about yourself.
1. What is the main language spoken in your home?
English
Other, please specify…………………………
2. Is this questionnaire in a language that you can easily understand?
Yes
No
No, I don’t understand the language but I had help from a friend or family member to fill in this questionnaire
3. What is the highest level of education you have achieved?
Finished school at or before the age of fifteen
Completed GCSEs, O-levels or equivalent
Completed A levels or equivalent
Completed further education but not a degree
Completed a Bachelor’s degree / master’s degree / PhD
Other, please specify………………………………..
4. If you have any suggestions on how we could improve this questionnaire, please write your comments overleaf. Thank you.