Readmissions after major gynecologic oncology surgery (NSQIP)

abstract

Highlights

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Readmission rate is dependent on several modifiable patient and treatment related factors.

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Three quarters of readmission happen within two weeks of discharge from the hospital

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Surgical site infections are the leading cause of readmissions

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Objectives

To examine the underlying indications, timing, and risk factors associated with unplanned hospital readmissions after major surgery for a gynecologic malignancy.

Methods

This is a retrospective database cohort study utilizing the National Surgical Quality Improvement Program database (NSQIP). The association between risk factors with respect to 30-day unplanned readmission was modeled using logistic regression. Timing of readmission and the primary reason of readmission was abstracted from the database.

Results

Overall, the unplanned readmission rate was 6.5% (832/12,804). On multivariate analysis, operative time ≥ 3 h (OR 1.39, p < 0.001), open abdominal surgery (OR 2.2, p < 0.001), any complication prior to discharge (OR 1.6, p < 0.001), two or more additional surgical procedures (OR 1.34, p = 0.003), or cervical cancer as the site of primary disease (OR 1.30, p = 0.05) were noted to be independent predictors of readmission. To provide a convenient calculation of overall probability of readmission, we developed a nomogram of factors significantly predicting readmission. Overall, infections were a cause of 45% of the readmissions. Surgical Site Infections were the most common reason, accounting for 29.2% of all readmissions. A majority of the readmissions (approximately 75%) were within two weeks of discharge from the hospital.

Conclusions

Efforts to reduce readmission rates should focus on identifying patients at a high risk of readmission and reducing surgical site infections. Additionally, prospective evaluation of interventions targeted at reducing readmissions should focus on the first two weeks after discharge from the hospital.