title: Association Between Preoperative Chemotherapy and Postoperative Complications in Patients Undergoing Surgery for Ovarian Cancer.
abstract: BACKGROUND
  This study sought to determine the association between preoperative chemotherapy and postoperative morbidity and mortality in ovarian cancer patients.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program was used to identify women who underwent surgery for ovarian cancer between 2005 and 2012. The women were divided into two groups based on whether they had received chemotherapy within 30 days before surgery or not. Preoperative variables, intraoperative measures, and postoperative morbidity and mortality were compared using χ(2) and Student's t test. Multivariable analyses using logistic regression modeling were used to correct for potential confounding variables.
  
  
  RESULTS
  Of 1807 patients, 1612 (89.2%) underwent primary surgery, and 195 (10.8%) received preoperative chemotherapy. The chemotherapy group had a lower preoperative platelet count (317,640 vs 249,740 plt/μL; P < 0.001), hematocrit (36.9 vs 33.1%; P < 0.001), and white blood cell (WBC) count (7970 vs 6060 WBC/μL; P < 0.001). Postoperatively, the chemotherapy group had a higher rate of organ/space infection (2.2 vs 4.6%; P = 0.04; odds ratio [OR], 2.12; 95% confidence interval [CI], 1.01-4.47) and a higher blood transfusion rate (17.1 vs 32.3%; P < 0.001; OR, 2.31; 95% CI, 1.67-3.20). A subanalysis of only those with disseminated cancer showed myelosuppression and an increased blood transfusion rate in the chemotherapy group. In multivariable analyses, preoperative chemotherapy, hematocrit, and ascites were independent predictors of postoperative blood transfusion in the entire cohort, whereas preoperative chemotherapy was the only independent predictor of postoperative blood transfusion in the disseminated cancer group.
  
  
  CONCLUSIONS
  Preoperative chemotherapy for the treatment of ovarian cancer is associated with myelosuppression and an increased risk of postoperative blood transfusion.
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA. david.doo@ucdenver.edu.
authors.forename: David W
authors.initials: DW
authors.lastname: Doo
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Guy
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Kian
authors.initials: K
authors.lastname: Behbakht
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Davidson
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Jeanelle
authors.initials: J
authors.lastname: Sheeder
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Saketh R
authors.initials: SR
authors.lastname: Guntupalli
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D009017:Morbidity; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D010052:Ovariectomy; D011183:Postoperative Complications; D011300:Preoperative Care; D011379:Prognosis; D058996:Quality Improvement; D018570:Risk Assessment