Risk Factors for Cardiopulmonary Complications in Surgeries for Benign Ovarian Tumors

ORIGINAL ARTICLE
S. N. Toneeva, N. A. Volkova, A. N. Mukhutdinova, S. Y. Klinysheva, T. V. Malova, A. F. Gilemkhanov, M. S. Muchkaev

 
For citation: Toneeva SN, Volkova NA, Mukhutdinova AN, Klinysheva SY, Malova TV, Gilemkhanov AF, Muchkaev MS. Risk Factors for Cardiopulmonary Complications in Surgeries for Benign Ovarian Tumors. International Journal of Biomedicine. 2025;15(1):150-154. doi:10.21103/Article15(1)_OA16
 
Originally published March 5, 2025

Abstract: 

Background: In recent years, advances in medical care have improved surgical outcomes in elderly patients with comorbidities, particularly in elective surgeries for non-malignant conditions. Assessing risk factors is crucial for enhancing safety in older patients undergoing surgery for benign ovarian cysts (BOC), given the increased potential for postoperative complications. This study aimed to identify key predictors of postoperative non-surgical complications in patients over 65 and to assess the incidence of these predictors, focusing on cardiorespiratory events.
Methods and Results: This retrospective study included 288 female patients aged ≥65 and under 65 who underwent elective surgery for benign ovarian cyst removal at a single clinical center. The primary outcome was the incidence of cardiorespiratory complications (CRC), with predictive factors such as obesity, hypertension, and age analyzed through univariate and multivariate models. The study utilized a Random Forest model to assess the predictive value of these risk factors and compared the predicted risk with observed complication rates to evaluate model accuracy. Calibration and complication odds ratios were computed to establish the significance of predictive variables.
Among the studied patients, obesity and hypertension emerged as significant independent predictors of postoperative CRC, while age alone did not contribute significantly to risk. CRC, including pneumonia, respiratory failure, arrhythmias, and hypertensive crises, were recorded in 8.7% of patients. The Random Forest model confirmed obesity and hypertension had a greater influence than age as determinants of complication risk, suggesting that comorbid conditions substantially increase postoperative risks.
Conclusion: This study highlights the importance of comorbidities, particularly obesity and hypertension, as primary predictors of postoperative complications in elderly patients undergoing surgery for BOC. Age alone was not a significant risk factor, indicating that tailored management of comorbid conditions may better mitigate postoperative risks than focusing on age as an isolated factor.

Keywords: 
benign ovarian cysts • cardiorespiratory complications • risk assessment • comorbidities
References: 
  1. Wolfman W, Thurston J, Yeung G, Glanc P. Guideline No. 404: Initial Investigation and Management of Benign Ovarian Masses. J Obstet Gynaecol Can. 2020 Aug;42(8):1040-1050.e1. doi: 10.1016/j.jogc.2020.01.014. PMID: 32736855.
  2. Serov VN, Kudryavtseva LI. Benign Tumors and Tumor-like Formations of the Ovaries. Moscow, 2001;152 pp. [In Russian].
  3. Timerbulatov VM, Timerbulatov ShV, Timerbulatov MV. Classification of surgical complications. Khirurgiya. Zhurnal Imeni N.I. Pirogova. 2018;9:61-65. [In Russian].
  4. Kaya AC, Radosa MP, Zimmermann JSM, Stotz L, Findeklee S, Hamza A, Sklavounos P, Takacs FZ, Wagenpfeil G, Radosa CG, Solomayer EF, Radosa JC. Intraoperative and postoperative complications of gynecological laparoscopic interventions: incidence and risk factors. Arch Gynecol Obstet. 2021 Nov;304(5):1259-1269. doi: 10.1007/s00404-021-06192-7. Epub 2021 Aug 21. PMID: 34417837; PMCID: PMC8490211.
  5. Xue B, Li D, Lu C, King CR, Wildes T, Avidan MS, Kannampallil T, Abraham J. Use of Machine Learning to Develop and Evaluate Models Using Preoperative and Intraoperative Data to Identify Risks of Postoperative Complications. JAMA Netw Open. 2021 Mar 1;4(3):e212240. doi: 10.1001/jamanetworkopen.2021.2240. PMID: 33783520; PMCID: PMC8010590.
  6. Wang J, Tozzi F, Ashraf Ganjouei A, Romero-Hernandez F, Feng J, Calthorpe L, Castro M, Davis G, Withers J, Zhou C, Chaudhary Z, Adam M, Berrevoet F, Alseidi A, Rashidian N. Machine learning improves prediction of postoperative outcomes after gastrointestinal surgery: a systematic review and meta-analysis. J Gastrointest Surg. 2024 Jun;28(6):956-965. doi: 10.1016/j.gassur.2024.03.006. Epub 2024 Mar 12. PMID: 38556418.
  7. Krishnan R, Rajpurkar P, Topol EJ. Self-supervised learning in medicine and healthcare. Nat Biomed Eng. 2022 Dec;6(12):1346-1352. doi: 10.1038/s41551-022-00914-1. Epub 2022 Aug 11. PMID: 35953649.
  8. Blacher J, Staessen JA, Girerd X, Gasowski J, Thijs L, Liu L, Wang JG, Fagard RH, Safar ME. Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch Intern Med. 2000 Apr 24;160(8):1085-9. doi: 10.1001/archinte.160.8.1085. PMID: 10789600.
  9. Yong PJ, Thurston J, Singh SS, Allaire C. Guideline No. 386-Gynaecologic Surgery in the Obese Patient. J Obstet Gynaecol Can. 2019 Sep;41(9):1356-1370.e7. doi: 10.1016/j.jogc.2018.12.005. PMID: 31443850.
  10. Ellulu MS, Patimah I, Khaza'ai H, Rahmat A, Abed Y. Obesity and inflammation: the linking mechanism and the complications. Arch Med Sci. 2017 Jun;13(4):851-863. doi: 10.5114/aoms.2016.58928. Epub 2016 Mar 31. PMID: 28721154; PMCID: PMC5507106.
  11. Tyan P, Amdur R, Berrigan M, Robinson H, Sparks A, Gu A, Wei C, Klebanoff J, Moawad G. Differences in Postoperative Morbidity among Obese Patients Undergoing Abdominal Versus Laparoscopic Hysterectomy for Benign Indications. J Minim Invasive Gynecol. 2020 Feb;27(2):464-472. doi: 10.1016/j.jmig.2019.04.001. Epub 2019 Apr 6. PMID: 30965116.
  12. Esposito K, Giugliano G, Scuderi N, Giugliano D. Role of adipokines in the obesity-inflammation relationship: the effect of fat removal. Plast Reconstr Surg. 2006 Sep 15;118(4):1048-1057. doi: 10.1097/01.prs.0000232281.49432.ce. PMID: 16980868.
  13. McMahon MD, Scott DM, Saks E, Tower A, Raker CA, Matteson KA. Impact of obesity on outcomes of hysterectomy. J Minim Invasive Gynecol. 2014 Mar-Apr;21(2):259-65. doi: 10.1016/j.jmig.2013.08.707. Epub 2013 Sep 4. PMID: 24012923; PMCID: PMC4285148.
  14. Tyan P, Amdur R, Berrigan M, Robinson H, Sparks A, Gu A, Wei C, Klebanoff J, Moawad G. Differences in Postoperative Morbidity among Obese Patients Undergoing Abdominal Versus Laparoscopic Hysterectomy for Benign Indications. J Minim Invasive Gynecol. 2020 Feb;27(2):464-472. doi: 10.1016/j.jmig.2019.04.001. Epub 2019 Apr 6. PMID: 30965116.

Download Article
Received November 11, 2024.
Accepted January 15, 2025.
©2025 International Medical Research and Development Corporation.