title: Morbidity and mortality of cytoreduction with intraperitoneal chemotherapy: outcomes from the ACS NSQIP database.
abstract: BACKGROUND
  Cytoreduction with intraperitoneal chemotherapy (IPC) for treatment of peritoneal surface malignancies is increasingly utilized. However, the described morbidity and mortality rates are based predominantly on the experience at high-volume centers. We analyzed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for a nationwide perspective on morbidity and mortality associated with IPC.
  
  
  METHODS
  The NSQIP database was queried for all patients undergoing IPC and cytoreduction from 2005 to 2011. Univariate and forward stepwise multivariate regression identified factors associated with 30-day death and morbidity.
  
  
  RESULTS
  A total of 795 patients underwent IPC. Patients underwent a median of seven operative procedures (range 2-13). Median hospital stay was 9 days (range 2-79 days). A total of 521 complications occurred in 249 (31 %) patients, and there were 19 (2.3 %) mortalities. The most common complications were bleeding (15.1 %) and sepsis (14.6 %). Univariate analysis identified age ≥60 years, ascites, weight loss, recent prior operation, albumin <3 g/dl, bilirubin ≥2 mg/dl, hematocrit ≤30 %, colon, spleen, small bowel, liver, kidney, diaphragm, and gastric resections, wound classification, operative time, and intraoperative transfusion requirement as significantly associated with death and morbidity. By multivariate analysis, age ≥60 years, preoperative albumin <3 g/dl, gastrectomy, operative time, and intraoperative transfusion requirement remained significantly associated with death and morbidity. Particularly high death and morbidity rates were associated with preoperative albumin <3 g/dl (58 %), gastrectomy (62 %), and operative time of >500 min (46 %).
  
  
  CONCLUSIONS
  In this nationwide cohort, the death and morbidity rate associated with cytoreduction and IPC is consistent with other large series. Age ≥60 years, albumin <3 g/dl, gastrectomy, operative time, and intraoperative transfusion requirement were associated with 30-day death and morbidity. These factors may help guide patient selection, counseling, and preoperative optimization before IPC.
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA, edmund.bartlett@uphs.upenn.edu.
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Bartlett
authors.forename: Chelsey
authors.initials: C
authors.lastname: Meise
authors.forename: Robert E
authors.initials: RE
authors.lastname: Roses
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Fraker
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
authors.forename: Giorgos C
authors.initials: GC
authors.lastname: Karakousis
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D010478:Chemotherapy, Cancer, Regional Perfusion; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D009369:Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D018579:Patient Selection; D011183:Postoperative Complications; D011379:Prognosis; D058996:Quality Improvement; D012307:Risk Factors; D012955:Societies, Medical; D015996:Survival Rate