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Original research
Measuring the impact of specific surgical complications after ovarian cancer cytoreductive surgery on short-term outcomes
  1. Arwa Mohammad1,
  2. Chiara Ainio2,
  3. Deepa Maheswari Narasimhulu3,
  4. Michaela McGree4,
  5. Amy L Weaver4,
  6. Amanika Kumar1,
  7. Annalisa Garbi2,
  8. Andrea Mariani1,
  9. Giovanni Aletti2,5,
  10. Francesco Multinu2,
  11. Carrie Langstraat1 and
  12. William Cliby1
    1. 1Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
    2. 2Department of Gynecologic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
    3. 3Division of Gynecologic Oncology, Community Memorial Hospital, Ventura, California, USA, Community Memorial Hospital, Ventura, California, USA
    4. 4Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
    5. 5Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
    1. Correspondence to Dr Arwa Mohammad, Department of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; mohammadam{at}health.missouri.edu

    Abstract

    Objective We sought to measure the impact of specific peri-operative complications after primary cytoreductive surgery on relevant patient outcomes and use of resources.

    Methods A cohort of patients with advanced ovarian cancer who underwent primary cytoreductive surgery at two institutions (2006–2016) were studied. Specific known complications (‘exposures’) within 30 days of surgery were evaluated to determine the impact on outcomes. Exposures included bowel leak, superficial surgical site infection, deep surgical site infection, venous thromboembolic event, and cardiac event. Outcomes were prolonged lengths of stay, readmission or non-home discharge, reoperation, organ failure, delay to adjuvant chemotherapy, and 90-day mortality. Population attributable risk (PAR) was used to estimate the proportion of adverse outcomes that could be prevented by elimination of a causal exposure and considers both the strength of the association and the prevalence of the complication; adjusted PARs (aPAR) were calculated using adjusted relative risks (aRR) adjusted for stage (IIIC vs IV) and American Society of Anesthesiology score (<3 vs ≥3).

    Results A cohort of 892 patients was included. Each of the evaluated exposures had an impact on readmission/non-home discharge (aPAR range 5.3 to 13.5). A venous thromboembolic event was significantly associated with 90-day mortality (aRR=2.9 (95% CI 1.3 to 6.7); aPAR=8.6 (95% CI −1.8 to 19.1)) and organ failure (aRR=4.7 (95% CI 2.3 to 9.5); aPAR=13.9 (95% CI 2.8 to 25.1)). Similarly, a cardiac event was most strongly associated with organ failure and was very impactful (aPAR=19.0 (95% CI 6.8 to 31.1)).

    Bowel leak was a major contributor to poor outcome, including reoperation (aPAR=45.5 (95% CI 34.3 to 56.6)), organ failure (aPAR=13.6 (95% CI 2.6 to 24.6)), readmission/non-home discharge (aPAR=5.3 (95% CI 1.6 to 9.0)), delay to adjuvant chemotherapy (aPAR=5.9 (95% CI 2.3 to 9.4)), and prolonged lengths of stay (aPAR=13.0 (95% CI 9.1 to 16.9)).

    Conclusion Going beyond reporting complications using common scales to measure their genuine impact provides important information for providers, patients, and payers. We report that less frequent exposures, including a venous thromboembolic event, cardiac events, and bowel leaks, have a high impact on patients and use of resources.

    • Carcinoma, Ovarian Epithelial
    • Postoperative complications
    • Postoperative Period

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/ijgc-2024-005456

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • X @giovanni_aletti, @Fmultinu

      • Presented at This research was presented as a focused plenary oral presentation at the Society of Gynecologic Oncology annual conference on Women’s Health March 2022 meeting (Phoenix, Arizona, USA).

      • Contributors AM: conceived and designed the analysis, collected the data, performed the analysis, wrote the paper. CA: conceived and designed the analysis, collected the data, performed the analysis. DMN: conceived and designed the analysis, collected the data. MMcG: performed the analysis. ALW: conceived and designed the analysis, performed the analysis. AK: collected and designed the analysis. AG: contributed the data or analysis tools. AM: contributed the data, collected the data. GA: conceived and designed the analysis, performed the analysis. FM, CL: conceived and designed the analysis, performed the analysis. WC: conceived and designed the analysis, performed the analysis, wrote the paper, author acting as guarantor.

      • Funding The European Union - Next Generation EU - NRRP M6C2 - Investment 2.1 Enhancement and strengthening of biomedical research in the NHS. WC receives philanthropic support from the Virgil S. Counseller, M.D. Professorship of Surgery, Mayo Clinic.

      • Competing interests None declared.

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