Ovarian cancer surgery in Germany: An analysis of the nationwide hospital file 2005–2015

Objectives: Nationwide hospitalization data on the surgical management of ovarian cancer are scant. We assessed type of surgery, surgical approach, length of stay, surgery-related complications and in-hospital mortality among women with ovarian cancer in Germany. We analyzed nationwide hospitalization file of 2005 through 2015 including 77,589 ovarian cancer-related hospitalizations associated with ovarian surgery. Methods: We calculated the relative frequency of the surgical approaches by type of surgery and calendar time. We used log-binomial regression models to estimate relative risk of in-hospital mortality (including 95% confidence intervals) according to complications. About 63% of the hospitalizations included an additional hysterectomy besides ovariectomy. Results: About 85% of the surgeries were performed by laparotomy. However, from 2005–2006 through 2013–2015, the proportion of laparoscopic ovariectomies (±salpingectomy) increased from 14% to 35%. The in-hospital mortality risks for laparotomic and laparoscopic surgery were 2.9% and 0.4%, respectively. Adjusted mortality risk ratios varied from 1.35 (95% confidence interval = 0.94–1.94) for bleedings requiring blood transfusion to 3.65 (95% confidence interval = 3.31–4.03) for postoperative infections. Conclusion: We observed a tendency away from laparotomy toward laparoscopy for ovariectomies (±salpingectomy) over time. Compared with laparotomy, laparoscopy was associated with lower risk of complications and death. All complications studied were associated with higher in-hospital mortality risk.