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Appendectomy at the time of ovarian cancer staging increases infectious complications: a National Surgical Quality Improvement Program (NSQIP) propensity score-stratified analysis
  1. Laurence Bernard1,
  2. Innie Chen2,3 and
  3. Tien Le3,4
  1. 1 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
  2. 2 Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
  3. 3 The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  4. 4 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Dr Laurence Bernard, Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON L8V 1C3, Canada; laurence.bernard13{at}me.com

Abstract

Objective Despite evidence that routine elective appendectomy at the time of staging surgery for ovarian cancer is not warranted, it remains common practice in gynecology oncology. The objective of this study was to compare the surgical complication rates of women undergoing surgery for suspected early-stage ovarian malignancy with concurrent appendectomy to those who did not undergo appendectomy.

Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) 2010–2017 data were used to analyze the patient characteristics and outcomes of women undergoing staging surgeries for suspected early ovarian cancer. Women with pre-operative ascites, disseminated cancer, concurrent bowel surgery, or cytoreductive surgery were excluded. Multivariate logistic regression and propensity score stratification were used to assess 30-day post-operative outcomes.

Results Three hundred and fifty-one of 2100 women (16.7%) underwent concurrent appendectomy at time of surgery, and the post-operative infection rate was 7.8%. Women with concurrent appendectomy had twice the odds of post-operative infection (OR 2.03, 95% CI 1.26 to 3.27) after controlling for clinically important risk factors. The increased odds of infection remained significant after propensity score stratification (OR 2.04, 95% CI 1.27 to 3.3). No association was observed with length of hospital stay, readmission, return to the operating room, or post-operative death.

Conclusions Appendectomy at time of surgery for suspected early-stage ovarian cancer is associated with significantly elevated odds of post-operative infection. Unless there is clinical suspicion for involvement, routine appendectomy should be abandoned in clinical practice.

  • ovarian cancer
  • surgical procedures
  • operative
  • surgical wound infection
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Footnotes

  • Twitter @laubernard

  • Contributors LB, IC, and TL contributed to the design of the study, participated in the drafting of the manuscript and approved the final version submitted. LB performed the statistical analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Data are available from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).

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