PT  - JOURNAL ARTICLE
AU  - Mohammad, Arwa
AU  - Ainio, Chiara
AU  - Narasimhulu, Deepa Maheswari
AU  - McGree, Michaela
AU  - Weaver, Amy L
AU  - Kumar, Amanika
AU  - Garbi, Annalisa
AU  - Mariani, Andrea
AU  - Aletti, Giovanni
AU  - Multinu, Francesco
AU  - Langstraat, Carrie
AU  - Cliby, William
TI  - Comparison of the Contracted Accordion, Expanded Accordion, and Clavien-Dindo complication grading scales after ovarian cancer cytoreduction
AID  - 10.1136/ijgc-2022-003962
DP  - 2023 May 01
TA  - International Journal of Gynecologic Cancer
PG  - 727--733
VI  - 33
IP  - 5
4099  - http://ijgc.bmj.com/content/33/5/727.short
4100  - http://ijgc.bmj.com/content/33/5/727.full
SO  - Int J Gynecol Cancer2023 May 01; 33
AB  - Objective To compare the ability of current complication reporting scales (Contracted Accordion Scale, Expanded Accordion Scale, Clavien-Dindo Scale) to reflect the severity of patient outcomes after cytoreductive surgery for ovarian cancer.Methods We included all patients undergoing primary debulking surgery for stage IIIC/IV ovarian cancer from 2006 to 2016 at two expert centers for ovarian cancer. Complications within 30 days of surgery were graded according to three scales. Outcomes included length of stay, mortality (90-day), and delayed initiation of chemotherapy (>42 days after surgery). Correlations were assessed using the Spearman rank correlation, and comparisons between groups were evaluated using the Wilcoxon rank-sum test and the χ2 test.Results Among the 892 patients, 185 (20.7%) patients had a grade 3 or higher complication per all scales. Patients with grade 3 or higher complications (compared with those with none, grade 1 or grade 2) had longer length of stay, higher 90-day mortality, and delayed initiation of chemotherapy. The expanded scales (Expanded Accordion Scale and Clavien Dindo Scale) provided a more refined characterization of outcome compared with the Contracted Accordion Scale. However, mortality was actually found to be as high as 25.0% for grade 5 complications using the Expanded Accordion Scale. Patients with organ failure or requiring an invasive procedure had significantly worse outcomes than those without either complication, highlighting the importance of separating these events.Conclusions All three scales demonstrated general correlation with important outcomes after ovarian cancer surgery. However, the expanded scales (Clavien Dindo Scale and Expanded Accordion Scale) used important events commonly encountered after cytoreductive surgery, provided a more refined view of the severity of complications, and should be used in reporting outcomes in ovarian cancer.Data are available upon reasonable request.