Risk Factors for Surgical Complications in Ovarian Cancer

A woman’s preoperative albumin level and the number of extended cytoreductive procedures performed were found to be the strongest predictors of perioperative morbidity when undergoing surgery for ovarian cancer, according to the results of a retrospective analysis published in Gynecologic Oncology.

“Given that those women who require multiple extended procedures are at highest risk, these data suggest that alternative treatment strategies should be considered in women who may require extended cytoreductive surgery,” wrote Sonali Patankar, MD, of Columbia University College of Physicians and Surgeons in New York, and colleagues.

According to the researchers, cytoreduction for ovarian cancer is associated with substantial morbidity, and in this analysis, they sought to identify if certain subgroups of patients may benefit from alternative treatments.

The researchers looked at 2,870 women from the National Surgical Quality Improvement Program database who had undergone surgery for ovarian cancer between 2005 and 2012.

Looking at outcomes by age, the researchers found that the perioperative complication rate was 9.5% in women aged less than 50 years, 13.4% in women aged 60 to 69 years, and 14.6% in women aged 70 years or older (P < .0001). In addition, women aged 70 years or older were at increased risk for prolonged hospitalization, non-routine discharge, transfusion, and death compared with patients aged less than 50 years.

The researchers conducted a multivariable analysis corrected for clinical and demographic characteristics and found that the number of extended cytoreductive procedures performed was consistently associated with worse perioperative morbidity. Specifically, three or more procedures were associated with four times the relative risk (RR) for any complication, five times the risk for severe complications, and more than three times the risk for wound complications. Undergoing more than three procedures was also associated with prolonged hospitalization (RR = 4.68; 95% confidence interval [CI], 3.22–6.80), non-routine discharge (RR = 2.82; 95% CI, 1.11–7.19), and transfusion (RR = 3.15; 95% CI, 2.14–4.63).

In the multivariable analysis, preoperative albumin levels were also found to be significantly associated with any complication, severe complications, prolonged hospitalization, non-routine discharge, transfusion, and reoperation (P < .05 for all).

“Somewhat surprisingly, neither age nor functional status was independently associated with morbidity or mortality,” the researchers noted.