Patient, Treatment and Discharge Factors associated with Hospital Readmission within 30 days after Surgical Cytoreduction for Epithelial Ovarian Carcinoma

Abstract

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Highlights

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Patient age, comorbidities and surgical radicality do not predict for readmission.

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Perioperative complications are highly associated with readmissions after cytoreduction.

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Discharge with visiting nurses or to rehabilitation facility is not associated with a reduction in readmission rate.

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Objective

Hospital readmissions are common, costly and increasingly viewed as adverse events. In gynecologic oncology, data on readmissions is limited. The goal of this study was to examine the patient, treatment and discharge factors associated with unplanned readmission after cytoreductive surgery.

Methods

We identified all patients with stage II-IV ovarian cancer who underwent surgical cytoreduction at our institution between 2003-2011. A retrospective chart review was performed and clinical variables extracted. Utilizing linear and logistic regression, these clinical variables were correlated with risk of readmission.

Results

A total of 460 patients were included in the analysis, with the majority having a Stage IIIC high grade serous cancer. Optimal cytoreduction (< 1.0cm residual disease) was obtained in 368 patients (81%) and 233 patients (50%) underwent at least one radical procedure. Perioperative complications were observed in 148 patients (32%). A large proportion of our cohort was discharged to rehabilitation facilities (12%) or with a visiting nurse (38%). Fifty five patients (12%) were readmitted within 30 days. On multivariate logistic regression, reoperation and perioperative cardiopulmonary event were the only factors associated with readmission (OR 3.2, 95% 1.7- 6.0). Discharge home with ancillary services was not protective against readmission, even when controlling for perioperative complications (OR 1.18, CI 0.53-2.64).

Conclusions

Readmission after surgical cytoreduction affected 12% of our population. Multivariate analyses suggested perioperative complications, particularly reoperation and cardiopulmonary event, placed the patient at the greatest risk. Age, comorbidities, surgical radicality and discharge with visiting nurse services/rehabilitation facility did not affect the likelihood of readmission.