Risk-prediction model of severe postoperative complications after primary debulking surgery for advanced ovarian cancer

• Postoperative complications after primary debulking surgery for advanced epithelial ovarian cancer are common and predictable based on risk factors.
• Age, albumin < 3.5 g/dL, surgical complexity, stage, ASA, and BMI influence morbidity and mortality after debulking surgery.
• Risk stratification may help in pre-operative counseling for patients with advanced ovarian cancer.

ObjectivesTo refine models to predict surgical morbidity and 90-day mortality after primary debulking surgery (PDS) for advanced epithelial ovarian cancer (EOC).MethodsWomen with stage IIIC/IV EOC who underwent PDS with curative intent between 1/2/2003 and 12/30/2011 were included. Patient characteristics, intraoperative and postoperative outcomes, and vital status were abstracted. Complications were graded using the Accordion classification. Nomograms were generated based on multivariate modeling.Results138 (22.3%) of the 620 patients who underwent PDS experienced a grade ≥ 3 complication. Age (OR 1.21 per 10 years increase in age), BMI (OR 1.35 for BMI < 25 kg/m2 versus reference, OR 2.83 for BMI ≥ 40 kg/m2 versus reference), ASA score ≥ 3 (OR 1.49), stage (OR 1.69 stage IV) and surgical complexity (OR 2.32 high complexity versus intermediate) were predictive of an accordion grade ≥ 3 complicationWithin 90 days of surgery, 55 (8.9%) patients died. A multivariable model included age (OR 1.76 per 10 year increase in age), ASA score ≥ 3 (OR 3.28), preoperative albumin < 3.5 (OR 4.31), and BMI (OR 2.04 for BMI < 25 kg/m2 versus reference, OR 3.64 for BMI ≥ 40 kg/m2 versus reference) was predictive of 90-day mortality.ConclusionUsing an independent cohort we report the importance of age, ASA score, preoperative albumin, FIGO stage, and surgical complexity, and BMI, to refine a prediction model for complications after PDS for advanced EOC. This information is useful in preoperative counseling and can be utilized to aid in patient-centered decision making and risk stratification.