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Predictors of Unplanned Reoperation for Ovarian Cancer Patients From the National Surgical Quality Improvement Program Database
  1. Michael D. Toboni, MD, MPH*,
  2. Haller J. Smith, MD,
  3. Sejong Bae, PhD,
  4. J. Michael Straughn, MD and
  5. Charles A. Leath, MD, MSPH
  1. *Department of Obstetrics & Gynecology and Divisions of
  2. Gynecologic Oncology and
  3. Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL.
  1. Address correspondence and reprint requests to Michael D. Toboni, MD, MPH, University of Alabama at Birmingham, 619 19th St S, 176F Room 5329, Birmingham, AL 35249. E-mail: mdtoboni{at}uabmc.edu.

Abstract

Objectives The aim of this study was to determine preoperative risk factors associated with unplanned reoperation within 30 days for patients undergoing major surgery for primary ovarian cancer using the National Surgical Quality Improvement Program database.

Methods We conducted a retrospective cohort study utilizing the National Surgical Quality Improvement Program database to identify patients undergoing primary ovarian cancer surgery from 2012 to 2014. Patients who had a reoperation within 30 days of their primary surgery were identified. Demographics and clinical covariates were calculated. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using univariate and multivariate logistic regression approaches to assess the association.

Results A total of 4260 patients were identified during the study period. One hundred forty-eight patients (3.5%) underwent a reoperation within 30 days of their primary surgery. In univariate analysis, preoperative creatinine 1.5 mg/dL or greater (P = 0.010), smoking (P = 0.003), and both insulin-dependent (P = 0.029) and non–insulin-dependent diabetes mellitus (P = 0.048) were predictive of a reoperation. Multivariate analysis noted that smoking (OR, 1.94; 95% CI, 1.26–2.99), insulin-dependent diabetes mellitus (OR, 2.18; 95% CI, 1.08–4.40), non–insulin-dependent diabetes mellitus (OR, 1.65; 95% CI, 1.01–2.72), and preoperative creatinine (OR, 2.65; 95% CI, 1.26–5.58) were predictive of a reoperation. Age 50 to 60 years was protective against reoperation when compared with age younger than 50 years (OR, 0.54; 95% CI, 0.32–0.90).

Conclusions Efforts to reduce reoperation rates should focus on identifying high-risk patients by utilizing objective preoperative data. Optimizing their medical status prior to surgery may decrease the reoperation rate in patients with ovarian cancer, thereby improving outcomes and providing a probable cost benefit.

  • NSQIP
  • Ovarian cancer
  • Unplanned reoperation

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Footnotes

  • Funding support was provided in part by NIH 3P30CA013148-43S3 and U10CA180855 to C.A.L.

  • This study was presented in part at the 2017 Society of Gynecologic Oncology Annual Meeting on Women's Cancer; National Harbor, Maryland; 2017.

  • The authors declare no conflicts of interest.

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