PMID- 30771346
OWN - NLM
STAT- Publisher
LR  - 20190407
IS  - 1097-6868 (Electronic)
IS  - 0002-9378 (Linking)
DP  - 2019 Feb 13
TI  - Development and validation of a risk-calculator for adverse perioperative
      outcomes for women with ovarian cancer.
LID - S0002-9378(19)30360-6 [pii]
LID - 10.1016/j.ajog.2019.02.019 [doi]
AB  - BACKGROUND: Primary cytoreduction followed by platinum-based chemotherapy is the 
      primary treatment for advanced ovarian cancer. However, neoadjuvant chemotherapy 
      followed by interval debulking is an alternative option, particularly in those
      who may be poor surgical candidates. OBJECTIVE: The objective of this study was
      to determine factors associated with short-term, significant perioperative
      morbidity and mortality for women undergoing surgery for ovarian cancer and to
      create a nomogram to predict the risk of adverse perioperative outcomes. STUDY
      DESIGN: We used the National Surgical Quality Improvement Program database to
      identify women with ovarian, fallopian tube, or primary peritoneal cancer who
      underwent surgery from 2011 to 2015. Demographic factors, clinical
      characteristics, comorbidity, functional status, and the extent of surgery were
      used to predict the risk of severe perioperative complications or death using
      multivariable models. Multiple imputation methods were employed for missing data.
      A nomogram was developed based on the final model. The discrimination ability of 
      the model was assessed with a calibration plot and discrimination concordance
      index. RESULTS: We identified a total of 7029 patients. Overall, 5.8% of patients
      experienced a Clavien-Dindo IV complication, 9.8% of patients were readmitted,
      3.0% of patients required a reoperation, and 0.9% of patients died within 30
      days. Among the baseline variables assessed, increasing age, emergent surgery,
      ascites, bleeding disorder, low albumin, higher American Society of
      Anesthesiology classification score, and a higher extended procedure score were
      associated with serious perioperative morbidity or mortality. Of these factors,
      performance of >/=3 cytoreductive procedures (adjusted odds ratio 4.53, 95%
      confidence interval 3.01-6.82), American Society of Anesthesiology classification
      score >/= class 4 (adjusted odds ratio 2.89, 95% confidence interval 1.17-7.14), 
      bleeding disorder (adjusted odds ratio 2.73, 95% confidence interval 1.82-4.10), 
      and age >/=80 years (adjusted odds ratio 2.46, 95% confidence interval 1.66-3.63)
      were most strongly associated with risk of an event. The final nomogram included 
      the above variables and had an internal discrimination concordance index of 0.71,
      with accurate predictions in an internal validation set, indicating a 71% correct
      identification of patients across all possible pairs. CONCLUSION: Women
      undergoing surgery for ovarian cancer are at significant risk for the occurrence 
      of adverse perioperative outcomes. Using readily identifiable characteristics,
      this nomogram can predict adverse outcomes.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Cham, Stephanie
AU  - Cham S
AD  - Columbia University College of Physicians and Surgeons, New York, NY; New York
      Presbyterian Hospital, New York, NY.
FAU - Chen, Ling
AU  - Chen L
AD  - Columbia University College of Physicians and Surgeons, New York, NY.
FAU - St Clair, Caryn M
AU  - St Clair CM
AD  - Columbia University College of Physicians and Surgeons, New York, NY; Herbert
      Irving Comprehensive Cancer Center, Columbia University College of Physicians and
      Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY.
FAU - Hou, June Y
AU  - Hou JY
AD  - Columbia University College of Physicians and Surgeons, New York, NY; Herbert
      Irving Comprehensive Cancer Center, Columbia University College of Physicians and
      Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY.
FAU - Tergas, Ana I
AU  - Tergas AI
AD  - Columbia University College of Physicians and Surgeons, New York, NY; Joseph L.
      Mailman School of Public Health, Columbia University, New York, NY; Herbert
      Irving Comprehensive Cancer Center, Columbia University College of Physicians and
      Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY.
FAU - Melamed, Alexander
AU  - Melamed A
AD  - Massachusetts General Hospital, Boston, MA.
FAU - Ananth, Cande V
AU  - Ananth CV
AD  - Joseph L. Mailman School of Public Health, Columbia University, New York, NY.
FAU - Neugut, Alfred I
AU  - Neugut AI
AD  - Columbia University College of Physicians and Surgeons, New York, NY; Joseph L.
      Mailman School of Public Health, Columbia University, New York, NY; Herbert
      Irving Comprehensive Cancer Center, Columbia University College of Physicians and
      Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY.
FAU - Hershman, Dawn L
AU  - Hershman DL
AD  - Columbia University College of Physicians and Surgeons, New York, NY; Joseph L.
      Mailman School of Public Health, Columbia University, New York, NY; Herbert
      Irving Comprehensive Cancer Center, Columbia University College of Physicians and
      Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY.
FAU - Wright, Jason D
AU  - Wright JD
AD  - Columbia University College of Physicians and Surgeons, New York, NY; Herbert
      Irving Comprehensive Cancer Center, Columbia University College of Physicians and
      Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY. Electronic 
      address: jw2459@columbia.edu.
LA  - eng
GR  - R01 CA169121/CA/NCI NIH HHS/United States
PT  - Journal Article
DEP - 20190213
PL  - United States
TA  - Am J Obstet Gynecol
JT  - American journal of obstetrics and gynecology
JID - 0370476
OTO - NOTNLM
OT  - complication
OT  - cytoreduction
OT  - debulking
OT  - ovarian cancer
EDAT- 2019/02/17 06:00
MHDA- 2019/02/17 06:00
CRDT- 2019/02/17 06:00
PHST- 2018/11/21 00:00 [received]
PHST- 2019/01/06 00:00 [revised]
PHST- 2019/02/07 00:00 [accepted]
PHST- 2019/02/17 06:00 [pubmed]
PHST- 2019/02/17 06:00 [medline]
PHST- 2019/02/17 06:00 [entrez]
AID - S0002-9378(19)30360-6 [pii]
AID - 10.1016/j.ajog.2019.02.019 [doi]
PST - aheadofprint
SO  - Am J Obstet Gynecol. 2019 Feb 13. pii: S0002-9378(19)30360-6. doi:
      10.1016/j.ajog.2019.02.019.