Thirty-day mortality after primary cytoreductive surgery for advanced ovarian cancer in the elderly

Abstract

Objective: To identify factors associated with increased 30-day mortality after advanced ovarian cancer debulking among elderly women.

Methods: A database linking Medicare records with the Surveillance, Epidemiology, and End Results (SEER) data was used to identify a cohort of 5,475 women aged 65 and older who had primary debulking surgery for stage III or IV epithelial ovarian cancer (diagnosed 1995-2005). Women were stratified by acuity of hospital admission. Multivariable analysis was performed to identify patient-related and treatment-related variables associated with 30-day mortality.

Results: Five thousand four hundred seventy-five women had surgery for advanced ovarian cancer, and the overall 30-day mortality was 8.2%. Women admitted electively had a 30-day mortality of 5.6% (251 of 4,517), and those admitted emergently had a 30-day mortality of 20.1% (168 of 835). Advancing age, increasing stage, and increasing comorbidity score were all associated with an increase in 30-day mortality (all P<.05) among elective admissions. A group of women at high risk admitted electively included those aged 75 or older with stage IV disease and women aged 75 or older with stage III disease and a comorbidity score of 1 or more. This group had an observed 30-day mortality of 12.7% (95% confidence interval 10.7%-14.9%).

Conclusion: Age, cancer stage, and comorbidity scores may be helpful to stratify electively admitted patients based on predicted postoperative mortality. If validated in a prospective cohort, then these factors may help identify women who may benefit from alternative treatment strategies.

Level of evidence: II.

Figure 1

30-day mortality for elderly women electively admitted for surgery for Stage III or Stage IV ovarian cancer without a history of neoadjuvant chemotherapy. N represents patients; percentage shows 30-day mortality rate, with 95% confidence intervals in parentheses. *Comorbidity score(19): 1 point each given for dementia, congestive heart failure, coronary artery disease (heart attack, angina or revascularization), diabetes, hypertension, peripheral vascular disease, pulmonary disease, renal disease or stroke; 2 points given for previous malignancy; 3 points given for hepatic disease.