title: A preoperative personalized risk assessment calculator for elderly ovarian cancer patients undergoing primary cytoreductive surgery.
abstract: OBJECTIVE
  Cytoreductive surgery for ovarian cancer has higher rates of postoperative complication than neoadjuvant chemotherapy followed by surgery. If patients at high risk of postoperative complication were identified preoperatively, primary therapy could be tailored. Our objective was to develop a predictive model to estimate the risk of major postoperative complication after primary cytoreductive surgery among elderly ovarian cancer patients.
  
  
  METHODS
  Patients who underwent primary surgery for ovarian cancer between 2005 and 2013 were identified from the National Surgical Quality Improvement Project. Patients were selected using primary procedure CPT codes. Major complications were defined as grade 3 or higher complications on the validated Claviden-Dindo scale. Using logistic regression, we identified demographic and clinical characteristics predictive of postoperative complication.
  
  
  RESULTS
  We identified 2101 ovarian cancer patients of whom 35.9% were older than 65. Among women older than 65, the rate of major postoperative complication was 16.4%. Complications were directly associated with preoperative laboratory values (serum creatinine, platelets, white blood cell count, hematocrit), ascites, white race, and smoking status, and indirectly associated with albumin. Our predictive model had an area under receiver operating characteristic curve of 0.725. In order to not deny patients necessary surgery, we chose a 50% population rate of postoperative complication which produced model sensitivity of 9.8% and specificity of 98%.
  
  
  CONCLUSIONS
  Our predictive model uses easily and routinely obtained objective preoperative factors to estimate the risk of postoperative complication among elderly ovarian cancer patients. This information can be used to assess risk, manage postoperative expectations, and make decisions regarding initial treatment.
authors.affiliation: University of North Carolina, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chapel Hill, NC, United States. Electronic address: embarber@med.unc.edu.
authors.forename: Emma L
authors.initials: EL
authors.lastname: Barber
authors.affiliation: University of North Carolina, Department of Health Policy and Management, Gillings School of Public Health, Chapel Hill, NC, United States; University of North Carolina, Division of Infectious Diseases, Department of Internal Medicine, Chapel Hill, NC, United States.
authors.forename: Sarah
authors.initials: S
authors.lastname: Rutstein
authors.affiliation: University of North Carolina, Division of Infectious Diseases, Department of Internal Medicine, Chapel Hill, NC, United States; University of North Carolina, Department of Epidemiology, Gillings School of Public Health, Chapel Hill, NC, United States.
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.affiliation: University of North Carolina, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chapel Hill, NC, United States; Lineberger Clinical Cancer Center, University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001201:Ascites / Q000209:etiology; D003404:Creatinine / Q000097:blood; D065426:Cytoreduction Surgical Procedures; D003661:Decision Support Techniques; D005260:Female; D006400:Hematocrit; D006801:Humans; D007958:Leukocyte Count; D010051:Ovarian Neoplasms / Q000097:blood / Q000150:complications / Q000601:surgery*; D010976:Platelet Count; D011183:Postoperative Complications / Q000453:epidemiology* / Q000208:ethnology; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012372:ROC Curve; D018570:Risk Assessment; D012709:Serum Albumin / Q000378:metabolism; D012907:Smoking / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
chemical_list: D012709:Serum Albumin; D003404:Creatinine
keywords: Elderly; Ovarian cancer; Postoperative complication; Risk assessment tool; Risk calculator; Risk score