Predictors of Postoperative Complications Following Cytoreductive Surgery With HIPEC: A Real-World Analysis of 493 Patients in Québec
Author(s)
Vincent McCarty, MSc1, Mikael Soucisse, MD2, Lucas Sideris, MD2, Neil R. Brett, PhD3, Marielle Bassel, BA3, John S. Sampalis, MSc, PhD3.
1Department of Surgery, McGill University, Montreal, QC, Canada, 2Department of Surgery, Université de Montréal, Montreal, QC, Canada, 3PPD™ Observational Studies, Thermo Fisher Scientific, Montreal, QC, Canada.
1Department of Surgery, McGill University, Montreal, QC, Canada, 2Department of Surgery, Université de Montréal, Montreal, QC, Canada, 3PPD™ Observational Studies, Thermo Fisher Scientific, Montreal, QC, Canada.
OBJECTIVES: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is commonly used to treat peritoneal malignant disease, however this procedure is associated with a high rate of post-operative complications. The aim of this study was to understand the factors associated with increased risk for complications following CRS with HIPEC.
METHODS: This was a real-world, retrospective cohort study on 487 patients, identified through medical record screening, who underwent CRS with HIPEC at Maisonneuve-Rosemont Hospital, Montréal, Canada between 2012 and 2023. Univariate and multivariate logistic regression with backwards conditional stepwise selection was used to identify independent predictors of post-operative complications (e.g., infections, anastomotic leaks).
RESULTS: Mean (SD) age was 58.2 (10.4) years, BMI was 26.5 (5.7) kg/m2, Charlson Comorbidity Index was 7.6 (1.1), operating time was 433 (135) minutes, intraoperative blood loss during procedure was 916 (785) ml and Peritoneal Cancer Index (PCI) was 12.3 (9.1). 66.9% of patients were female. The distribution of cancer origins was colorectal (36.1%), ovarian (27.1%), appendix (25.1%), peritoneum (8.2%), and other (3.5%). 17.1% of patients received a pre-operative transfusion. 70.2% of patients experienced ≥1 complication, however only 22.3% had a complication classified as Clavien-Dindo ≥3a. Multivariate logistic regression (OR [95%CI]) identified age: 1.032 (1.010-1.055), blood loss: 1.001 (1.000-1.001), and intraoperative PCI: 1.073 (1.038-1.110) as predictors of increased risk for ≥ 1 post-operative complication.
CONCLUSIONS: In this patient cohort, older age, increased blood loss, and a higher intraoperative PCI were associated with increased risk of post-operative complications. As a complex and lengthy procedure, it is acknowledged that CRS with HIPEC has a high risk of complications; but increased post-operative attention may be warranted for patients with these risk factors. This study emphasizes the importance of real-world evidence in identifying clinical factors that may improve patient outcomes following complex surgical procedures.
METHODS: This was a real-world, retrospective cohort study on 487 patients, identified through medical record screening, who underwent CRS with HIPEC at Maisonneuve-Rosemont Hospital, Montréal, Canada between 2012 and 2023. Univariate and multivariate logistic regression with backwards conditional stepwise selection was used to identify independent predictors of post-operative complications (e.g., infections, anastomotic leaks).
RESULTS: Mean (SD) age was 58.2 (10.4) years, BMI was 26.5 (5.7) kg/m2, Charlson Comorbidity Index was 7.6 (1.1), operating time was 433 (135) minutes, intraoperative blood loss during procedure was 916 (785) ml and Peritoneal Cancer Index (PCI) was 12.3 (9.1). 66.9% of patients were female. The distribution of cancer origins was colorectal (36.1%), ovarian (27.1%), appendix (25.1%), peritoneum (8.2%), and other (3.5%). 17.1% of patients received a pre-operative transfusion. 70.2% of patients experienced ≥1 complication, however only 22.3% had a complication classified as Clavien-Dindo ≥3a. Multivariate logistic regression (OR [95%CI]) identified age: 1.032 (1.010-1.055), blood loss: 1.001 (1.000-1.001), and intraoperative PCI: 1.073 (1.038-1.110) as predictors of increased risk for ≥ 1 post-operative complication.
CONCLUSIONS: In this patient cohort, older age, increased blood loss, and a higher intraoperative PCI were associated with increased risk of post-operative complications. As a complex and lengthy procedure, it is acknowledged that CRS with HIPEC has a high risk of complications; but increased post-operative attention may be warranted for patients with these risk factors. This study emphasizes the importance of real-world evidence in identifying clinical factors that may improve patient outcomes following complex surgical procedures.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO184
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
Oncology