Postoperative pulmonary complications and outcomes in cytoreductive surgery for ovarian cancer: a propensity-matched analysis

Mengmeng Xu; Wei Zhang; Chen Gao; Ying Zhou; Yanhu Xie

doi:10.1186/s12871-022-01660-2

Postoperative pulmonary complications and outcomes in cytoreductive surgery for ovarian cancer: a propensity-matched analysis

BMC Anesthesiol. 2022 Apr 23;22(1):120. doi: 10.1186/s12871-022-01660-2.

Authors

Mengmeng Xu¹, Wei Zhang¹, Chen Gao¹, Ying Zhou², Yanhu Xie³

Affiliations

¹ Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China.
² Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China.
³ Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China. xyh200701@163.com.

Abstract

Objectives: To assess the prevalence of postoperative pulmonary complications (PPCs), the perioperative factors associated with PPCs, and the association of PPCs with postoperative outcomes in ovarian cancer patients undergoing cytoreductive surgery.

Methods: A retrospective analysis was conducted on patients who underwent cytoreductive surgery in our hospital, between September 2017 and January 2021, and patient medical records were reviewed to collect relevant clinical information. Univariable and multivariable analyses were used to identify significant risk factors for PPCs. Analysis of the association of PPCs with postoperative outcomes, mortality and 30-day readmission, was undertaken utilizing propensity score-matched controls and multivariable logistic regression model.

Results: Final analysis was performed with 268 ovarian cancer patients after cytoreductive surgery, among whom the incidence of PPCs was 26.9%, and the most frequent pulmonary complication was pleural effusion. According to the multivariate analysis, the intraoperative fluid infusion volume (L) (odds ratio (OR) 1.34; 95% confidence intervals (CI) 1.01-1.77; P = 0.040), diameter size of diaphragmatic resection (cm) (OR 1.16; 95% CI 1.06-1.28; P = 0.002), and surgical complexity scores (OR 1.26; 95% CI 1.13-1.42; P < 0.001) were significantly associated with the development of PPCs. The multivariable logistic regression analyses with propensity-matched controls demonstrated that the occurrence of PPCs significantly increased the risk of 30-day readmission (OR 6.01; 95% CI 1.12-32.40; P = 0.037) and did not significantly affect inpatient mortality.

Conclusion: Ovarian cancer patients undergoing cytoreductive surgery, especially those with diaphragmatic resection or higher surgical complexity scores, represent a high-risk population for PPCs. In addition, goal-directed fluid therapy is vital to reducing the occurrence of PPCs in patients at risk. PPCs were not associated with in-hospital mortality but were significantly associated with an increased risk of 30-day readmission after cytoreductive surgery.

Keywords: Cytoreductive surgery; Diaphragmatic resection; Outcome; Postoperative pulmonary complications.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cytoreduction Surgical Procedures / adverse effects
Female
Humans
Lung Diseases* / epidemiology
Ovarian Neoplasms* / surgery
Postoperative Complications / etiology
Retrospective Studies
Risk Factors