title: 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%).
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  II.
authors.affiliation: From the Departments of Obstetrics and Gynecology and Surgery, University of Washington School of Medicine, and the Surgical Outcomes Research Center, University of Washington, Seattle, Washington.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Thrall
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Goff
authors.forename: Rebecca Gaston
authors.initials: RG
authors.lastname: Symons
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Gray
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006278:Medicare / Q000706:statistics & numerical data; D015233:Models, Statistical; D015999:Multivariate Analysis; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D018426:SEER Program; D014481:United States