Predictors of post-operative morbidity and mortality after debulking surgeries for gynecological malignancies.

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Background: Gynecological malignancies, particularly ovarian and endometrial cancers, represent a major contributor to cancer-related morbidity and mortality globally and in India. Debulking surgery remains the cornerstone of treatment for advanced cases, but these procedures are associated with significant perioperative risks that can impact recovery and delay adjuvant therapy. This study aimed to identify predictors of 30-day postoperative morbidity and 90-day mortality following debulking surgeries for gynecological malignancies in an Indian tertiary care setting. Methods: We conducted a retrospective observational study at the National Cancer Institute, AIIMS Jhajjar, including 100 patients undergoing debulking surgery for ovarian, endometrial, or related gynecologic malignancies between January 2022 and June 2023. Data on demographics, disease stage, surgical details, intraoperative events, and postoperative outcomes were collected. Univariate and multivariable logistic regression analyses were performed to identify significant predictors of morbidity and mortality. Results: Major 30-day morbidity occurred in 42% of patients, while no 90-day mortality was noted. On univariate analysis, surgical duration >300 minutes (2.72 [1.15 to 6.44]; p=0.021), sustained hypotension (2.67 [1.05 to 6.75]; p=0.035), blood loss ≥500 ml (2.56 [1.11 to 5.89]; p=0.025), and intraoperative blood transfusion (3.70[1.60 to 8.53]; p=0.002 were significantly associated with increased morbidity. Multivariable analysis revealed that intermediate or high surgical complexity was protective against 30-day morbidity (OR 0.163; 95% CI 0.034–0.792; p=0.025). Conclusions: Prolonged surgery, blood loss, and hemodynamic instability predict postoperative morbidity, while appropriately selected patients can safely undergo complex debulking procedures. Risk stratification and perioperative optimization are essential to improving outcomes. Future research should validate these findings prospectively and assess the effectiveness of targeted interventions.