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Higher Surgery Volume Tied to Better Survival for Frail Patients With Ovarian Cancer

According to a study presented by Morcos Nakhla, a medical student at the University of California - Los Angeles, at the 2021 SGO Virtual Annual Meeting on Women’s Cancer, frail patients with ovarian cancer who undergo surgery at institutions with higher surgical volume have lower inpatient mortality rates.

“Frailty has been associated with worse clinical outcomes following many operations, ways to assess frailty pre-operatively may inform decision making and guide pre-operative care. The objective of our study is to assess the impact of frailty on surgical outcomes in patients undergoing operations for ovarian cancer,” explained Mr Nakhla. 

To identify patients, researchers used the national inpatient sample database from 2005-2017, along with the International Classification of Diseases-9th and -10th revision codes in concurrence with the John Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses indicator. They also applied multivariate regression models to assess the association of frailty with postoperative outcomes.

An estimated 12,085 of 198,820 patients were considered frail (6.1%), these patients were also older (66 vs 60 years; P <.001) and had a greater burden of comorbidities (4.3 v.s 2.9; P <.001). As the study period continued, however, the number of frail patients undergoing surgery increased (P <.001), while the overall rate of in-hospital mortality decreased (P <.001).

Following adjustment for patient and hospital characteristics, researchers found an increased likelihood of mortality (adjusted odds ratio [AOR], 2.5; CI, 1.8-3.6), non-home discharge (AOR, 3.4; CI 2.9 -4.0) and complications (AOR, 1.6; CI, 1.4-1.8), including respiratory (AOR, 1.8; CI 1.6-2.0), and infectious (AOR, 1.9; CI, 1.6-2.3) complications. 

The researchers also found that frail patients were less likely to be treated at high-volume institutions (31% vs 36%; P = .012), but those who were saw decreased mortality rates. 

“The probability of mortality, while still significantly higher for frail patients each year compared to non-frail counterparts, decreases for frail patients specifically throughout the study period,” Mr Nakhla added.

“Finally, we also find that higher surgical volume is associated with decreased mortality for frail patients,” he concluded.—Alexandra Graziano


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