Surgical care of elderly women with ovarian cancer: A population-based perspective

Objective. To characterize the primary surgical care and short-term outcomes for ovarian cancer in women aged 80 years and older compared to women younger than 80 years. Methods. A statewide hospital discharge database was used to identify women undergoing primary surgery for ovarian cancer from 1990 to 2000. Logistic regression models were used to evaluate for significant differences in demographic characteristics and short-term outcomes comparing women aged ≥80 years with those aged <80 years. Results. A total of 2417 women were identified; women aged ≥80 years comprised 7.0% (n = 168) of cases. Compared to younger women, those aged ≥80 years were significantly more likely to be admitted under emergent conditions (25.6% vs. 14.9%, P < 0.0003) and less likely to undergo surgery at a university hospital (6.6% vs. 18.6%, P = 0.001). Ovarian cancer patients aged ≥80 years were significantly more likely to have a longer hospital stay (median 10 days vs. 7 days, P < 0.0001) and a higher adjusted cost of hospital related care (median $76,760 vs. $52,649, P < 0.0001). The 30-day mortality rate was 2.3-fold higher for women aged ≥80 years (5.4% vs. 2.4%, P = 0.036). For women aged ≥80 years, there was a trend toward a higher risk of peri-operative death among low-volume hospitals (8.8%) compared to high-volume hospitals (3.0%, P = 0.16). Conclusion. Primary surgical care for ovarian cancer in women aged ≥80 years is associated with utilization of significant health care resources and worse short-term outcomes compared to younger women. Additional research is needed to identify opportunities for improving the cost-effectiveness of care in this population.