Elsevier

Gynecologic Oncology

Volume 142, Issue 3, September 2016, Pages 471-476
Gynecologic Oncology

Preoperative hyponatremia in women with ovarian cancer: An additional cause for concern?

https://doi.org/10.1016/j.ygyno.2016.06.018Get rights and content

Highlights

  • Preoperative hyponatremia is associated with postoperative complications in ovarian cancer patients.

  • This association remains significant after adjusting for ascites and albumin.

  • Hyponatremia may be used with other preoperative lab abnormalities to predict perioperative risk.

Abstract

Objective

To determine if preoperative hyponatremia in women with ovarian, fallopian tube (FT), and primary peritoneal cancers (PPC) is associated with postoperative complications.

Methods

We performed a retrospective population-based cohort study of women with a postoperative diagnosis of ovarian, FT, or PPC who had a cytoreductive procedure in the National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2013. The primary exposure, preoperative sodium, was classified as normal (135 mEq/L–142 mEq/L) or hyponatremic (≤ 134 mEq/L). Where appropriate, preoperative characteristics were compared with Chi-squared or Fisher's exact tests. Multivariate logistic regression was used to determine adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Results

4009 subjects met inclusion criteria. Thirty day mortality was higher in the hyponatremic group compared to the normal serum sodium group (3.56% vs 1.18%). When patients of any age were noted to have at least two pertinent preoperative lab abnormalities, including hyponatremia, there was an increased risk of postoperative complications for patients over the age of 65 (Table 3). After adjusting for serum albumin and other confounders, preoperative hyponatremia was associated with an increased risk of hospital stay of > 14 days (aOR 1.69; 95% CI 1.11–2.57) and 30 day postoperative mortality (aOR 2.37; 95% CI 1.13–4.98).

Conclusions

Hyponatremia is associated with postoperative 30 day mortality and morbidity in women with ovarian, FT, and PPC. Serum sodium in conjunction with other markers may have the potential to identify candidates for neoadjuvant chemotherapy. Additional work is needed to determine if correction of hyponatremia in the preoperative period alters outcomes.

Section snippets

Background

The optimal therapy for advanced ovarian cancer includes both surgery and chemotherapy [1]. Cytoreductive surgery to a goal of minimal residual disease has been associated with improvements in disease-free and overall survival [2]. Extensive surgical procedures are often required to achieve the goal of complete cytoreduction [3], [4] which can be associated with substantial morbidity as well as mortality [5]. In order to reduce the morbidity of surgery, neoadjuvant chemotherapy (NAC) may be

Data source/study design

ACS NSQIP is a surgical quality improvement program designed to measure and improve surgical outcomes. Currently, 699 hospitals nationwide participate in the ACS NSQIP program. The ACS NSQIP database contains variables on preoperative and intraoperative factors, and postoperative 30-day morbidity and mortality on patients who underwent major outpatient or inpatient surgical procedures. Surgical cases are selected using an 8-day cycle systematic sampling process at each site to minimize selection

Results

Four thousand seven hundred eighty-eight women with ovarian, PPC, and FT cancers were identified in the ACS NSQIP database from 2005 to 2013. Subjects with a missing preoperative serum sodium measurement (n = 354), hypernatremia (n = 350) and those that did not have a cytoreductive procedure (n = 75) were excluded. This left 4009 evaluable women. Women who were excluded for a missing preoperative serum sodium were more likely to be younger and were less likely to have preoperative weight loss,

Discussion

Hyponatremia is the most common electrolyte abnormality among hospitalized patients. We found that women with preoperative hyponatremia undergoing cytoreductive procedures for ovarian, PPC, and FT were more likely to experience 30-day postoperative complications such as prolonged hospital stay and 30-day mortality. Few studies have examined the association between preoperative hyponatremia and perioperative complications. The most notable was a large population-based study that used the NSQIP

Conflict of interest statement

The authors declare that there are no conflicts of interest.

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Accepted as a poster presentation at the Annual Meeting of the Society for Gynecologic Oncology, San Diego, CA, March 2016.

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