Post-surgical wound complications more common in obese ovarian cancer patients

1. Obese women were more likely to experience wound complications.

2. Obese women were more likely to have ≥2 comorbidities and be classified as American Society of Anesthesiologists (ASA) grade 3 (severe systemic disease).

Evidence Rating Level: 2 (Good)   

Study Rundown: Ovarian cancer is the most common cause of gynecologic cancer death in the U.S., with approximately 22 000 new cases annually. Risk factors for ovarian cancer include increasing age, nulliparity, infertility and genetic mutations. Staging and initial management for ovarian cancer is primarily surgical. As the number of obese individuals in the U.S. continues to grow, it is necessary to consider the impact of obesity on surgical outcomes. Prior studies have suggested that obese patients are at increased risk for surgical complications; this may in part be due to the increased prevalence of comorbidities in this patient population. There has been limited research exploring this issue in the case of ovarian cancer, and existing results have been inconsistent. In the present work, authors evaluated complications and intra- and post-operative outcomes in women undergoing surgical management for ovarian cancer through a retrospective cohort study and a systematic meta-analysis. In the primary study and meta-analysis, findings demonstrate that morbid obesity was associated with increased wound complications.

Strengths included evaluation of both individual and composite complications as well as short- and longer-term outcomes. The primary study is limited by retrospective design and the systematic review by small number of included studies. Prospective cohort studies are needed to better characterize the influence of BMI on surgical outcomes in order to risk stratify patients.

Click to read the study in BJOG

Relevant Reading: Impact of obesity on surgical and oncologic outcomes in ovarian cancer

In-Depth [retrospective cohort]: This study evaluated the impact of being overweight and/or obese on surgical outcomes among 228 women with primary ovarian cancer. BMI was categorized as <25 kg/m2 (n = 84), 25-29.9 kg/m2 (n = 84), 30-39.9 kg/m2 (n = 47), and ≥40 kg/m2 (n = 13). The primary outcome of interest was surgical complications. Intra- and post- operative outcomes were also measured.

In the primary study, women with BMI ≥40 kg/m2 were more likely to experience wound complications (p = 0.027). Obese women were also more likely to have ≥2 comorbidities (p = 0.033) and be ASA grade 3 (p < 0.001). In the meta-analysis, obese patients were more likely to experience wound complications (OR 4.81, CI 2.40-9.62).

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