Failure to rescue following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Kevin Y. Li, Ali A. Mokdad, Rebecca M. Minter, John C. Mansour, Michael A. Choti, Mathew M. Augustine, Patricio M. Polanco

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) can significantly improve the survival in selected patients with peritoneal carcinomatosis. This study aims to identify perioperative patient characteristics predictive of failure to rescue (FTR), mortality following postoperative complications from CRS/HIPEC. Methods Patients suffering a complication following CRS/HIPEC between 2005 and 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program data set. FTR was defined as 30-d mortality in the setting of a complication. Patients who suffered FTR were compared against those who survived a complication (non-FTR). Predictors of FTR were identified using a multivariable logistic regression model. Results A total of 915 eligible CRS/HIPEC cases were identified. In all, 382 patients (42%) developed ≥1 postoperative complication, and 88 patients (10%) suffered ≥1 major complication. Seventeen patients died following a complication, amounting to an FTR rate of 4%. FTR patients were more likely than non-FTR patients to have dependent functional status (18% versus 2%, P = 0.01), have American Society of Anesthesiologists (ASA) class 4 status (29% versus 8%, P = 0.01), develop ≥3 complications (65% versus 24%, P < 0.01), and suffer a major complication (94% versus 20%, P < 0.01). The following were independently associated with FTR: ASA class 4 (odds ratio [OR]: 13.4, 95% confidence interval [CI], 1.2-146.8) and major complications (OR: 66.0, 95% CI, 8.4-516.6). Conclusions ASA class 4, major morbidity, and likely dependent functional status are independent predictors of FTR following CRS/HIPEC to treat peritoneal carcinomatosis. Therefore, ASA class 4 and dependent functional status should be considered as contraindications for CRS/HIPEC and only offered in highly selective cases.

Original languageEnglish (US)
Pages (from-to)209-215
Number of pages7
JournalJournal of Surgical Research
Volume214
DOIs
StatePublished - Jun 15 2017

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Drug Therapy
Logistic Models
Odds Ratio
Confidence Intervals
Carcinoma
Mortality
Quality Improvement
Morbidity
Survival
Anesthesiologists

Keywords

  • Cytoreductive surgery
  • FTR
  • Hyperthermic intraperitoneal chemotherapy

ASJC Scopus subject areas

  • Surgery

Cite this

Failure to rescue following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. / Li, Kevin Y.; Mokdad, Ali A.; Minter, Rebecca M.; Mansour, John C.; Choti, Michael A.; Augustine, Mathew M.; Polanco, Patricio M.

In: Journal of Surgical Research, Vol. 214, 15.06.2017, p. 209-215.

Research output: Contribution to journalArticle

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title = "Failure to rescue following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy",
abstract = "Background Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) can significantly improve the survival in selected patients with peritoneal carcinomatosis. This study aims to identify perioperative patient characteristics predictive of failure to rescue (FTR), mortality following postoperative complications from CRS/HIPEC. Methods Patients suffering a complication following CRS/HIPEC between 2005 and 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program data set. FTR was defined as 30-d mortality in the setting of a complication. Patients who suffered FTR were compared against those who survived a complication (non-FTR). Predictors of FTR were identified using a multivariable logistic regression model. Results A total of 915 eligible CRS/HIPEC cases were identified. In all, 382 patients (42{\%}) developed ≥1 postoperative complication, and 88 patients (10{\%}) suffered ≥1 major complication. Seventeen patients died following a complication, amounting to an FTR rate of 4{\%}. FTR patients were more likely than non-FTR patients to have dependent functional status (18{\%} versus 2{\%}, P = 0.01), have American Society of Anesthesiologists (ASA) class 4 status (29{\%} versus 8{\%}, P = 0.01), develop ≥3 complications (65{\%} versus 24{\%}, P < 0.01), and suffer a major complication (94{\%} versus 20{\%}, P < 0.01). The following were independently associated with FTR: ASA class 4 (odds ratio [OR]: 13.4, 95{\%} confidence interval [CI], 1.2-146.8) and major complications (OR: 66.0, 95{\%} CI, 8.4-516.6). Conclusions ASA class 4, major morbidity, and likely dependent functional status are independent predictors of FTR following CRS/HIPEC to treat peritoneal carcinomatosis. Therefore, ASA class 4 and dependent functional status should be considered as contraindications for CRS/HIPEC and only offered in highly selective cases.",
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AU - Li, Kevin Y.

AU - Mokdad, Ali A.

AU - Minter, Rebecca M.

AU - Mansour, John C.

AU - Choti, Michael A.

AU - Augustine, Mathew M.

AU - Polanco, Patricio M.

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N2 - Background Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) can significantly improve the survival in selected patients with peritoneal carcinomatosis. This study aims to identify perioperative patient characteristics predictive of failure to rescue (FTR), mortality following postoperative complications from CRS/HIPEC. Methods Patients suffering a complication following CRS/HIPEC between 2005 and 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program data set. FTR was defined as 30-d mortality in the setting of a complication. Patients who suffered FTR were compared against those who survived a complication (non-FTR). Predictors of FTR were identified using a multivariable logistic regression model. Results A total of 915 eligible CRS/HIPEC cases were identified. In all, 382 patients (42%) developed ≥1 postoperative complication, and 88 patients (10%) suffered ≥1 major complication. Seventeen patients died following a complication, amounting to an FTR rate of 4%. FTR patients were more likely than non-FTR patients to have dependent functional status (18% versus 2%, P = 0.01), have American Society of Anesthesiologists (ASA) class 4 status (29% versus 8%, P = 0.01), develop ≥3 complications (65% versus 24%, P < 0.01), and suffer a major complication (94% versus 20%, P < 0.01). The following were independently associated with FTR: ASA class 4 (odds ratio [OR]: 13.4, 95% confidence interval [CI], 1.2-146.8) and major complications (OR: 66.0, 95% CI, 8.4-516.6). Conclusions ASA class 4, major morbidity, and likely dependent functional status are independent predictors of FTR following CRS/HIPEC to treat peritoneal carcinomatosis. Therefore, ASA class 4 and dependent functional status should be considered as contraindications for CRS/HIPEC and only offered in highly selective cases.

AB - Background Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) can significantly improve the survival in selected patients with peritoneal carcinomatosis. This study aims to identify perioperative patient characteristics predictive of failure to rescue (FTR), mortality following postoperative complications from CRS/HIPEC. Methods Patients suffering a complication following CRS/HIPEC between 2005 and 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program data set. FTR was defined as 30-d mortality in the setting of a complication. Patients who suffered FTR were compared against those who survived a complication (non-FTR). Predictors of FTR were identified using a multivariable logistic regression model. Results A total of 915 eligible CRS/HIPEC cases were identified. In all, 382 patients (42%) developed ≥1 postoperative complication, and 88 patients (10%) suffered ≥1 major complication. Seventeen patients died following a complication, amounting to an FTR rate of 4%. FTR patients were more likely than non-FTR patients to have dependent functional status (18% versus 2%, P = 0.01), have American Society of Anesthesiologists (ASA) class 4 status (29% versus 8%, P = 0.01), develop ≥3 complications (65% versus 24%, P < 0.01), and suffer a major complication (94% versus 20%, P < 0.01). The following were independently associated with FTR: ASA class 4 (odds ratio [OR]: 13.4, 95% confidence interval [CI], 1.2-146.8) and major complications (OR: 66.0, 95% CI, 8.4-516.6). Conclusions ASA class 4, major morbidity, and likely dependent functional status are independent predictors of FTR following CRS/HIPEC to treat peritoneal carcinomatosis. Therefore, ASA class 4 and dependent functional status should be considered as contraindications for CRS/HIPEC and only offered in highly selective cases.

KW - Cytoreductive surgery

KW - FTR

KW - Hyperthermic intraperitoneal chemotherapy

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