Abstract
Abstract
Objectives:
Primary cytoreductive surgery (PCS) has been the standard initial management for ovarian cancer. In addition to predicting the likelihood of optimal debulking, predicting mortality and serious morbidity after PCS should be considered when deciding between PCS and neoadjuvant chemotherapy (NACT). The goal of this research was to develop a model to predict mortality and serious morbidity after PCS.
Materials and Methods:
This was a retrospective cohort study. Patients who underwent PCS were identified in the National Surgical Quality Improvement Program database (NSQIP) from 2006 to 2012. Outcomes collected included 30-day mortality and serious morbidity (wound dehiscence, abscess, sepsis, septic shock, stroke, coma, myocardial infarction, cardiac arrest, pulmonary embolism, unplanned intubation, and ventilator dependence for more than 48 hours). A backward selection procedure was utilized to identify model parameters. The proposed model (
Results:
Of the cohort (N = 2262), 194 (8.6%) patients with the outcome (30-day mortality and serious morbidity) were identified. Nine preoperative variables were included in the primary model; the model's area under the curve (AUC) was 0.66. To account for advanced-stage disease, a subset of patients with disseminated cancer was identified. The final model included 6 preoperative clinical variables: age, chronic hypertension requiring medication, ascites, white blood-cell count, hematocrit, and serum creatinine. The model AUC was 0.73.
Conclusions:
The risk of mortality and morbidity after PCS should be considered in deciding between PCS and NACT. A model was developed, using 6 preoperative clinical variables, allows risk estimation to help gynecologic oncologists quantify surgical mortality and severe morbidity after PCS. (J GYNECOL SURG 34:1)
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