Clinical Factors Associated with Longer Hospital Stay Following Ovarian Cancer Surgery

Abstract

Background: Ovarian cancer (OC) is the leading cause of death from gynecologic malignancy and is treated with a combination of cytoreductive surgery and platinum-based chemotherapy. Extended length of stay (LOS) after surgery can affect patient morbidity, overall costs, and hospital resource utilization. The primary objective of this study was to identify factors contributing to prolonged LOS for women undergoing surgery for ovarian cancer. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify women from 2012–2016 who underwent hysterectomy for ovarian, fallopian tube and peritoneal cancer. The primary outcome was LOS >50th percentile. Preoperative and intraoperative variables were examined to determine which were associated with prolonged LOS. Results: From 2012–2016, 1771 women underwent elective abdominal surgery for OC and were entered in the ACS-NSQIP database. The mean and median LOS was 4.6 and 4.0 days (IQR 0–38), respectively. On multivariate analysis, factors associated with prolonged LOS included: American Society of Anesthesiologists (ASA) Classification III (aOR 1.71, 95% CI 1.38–2.13) or IV (aOR 1.88, 95% CI 1.44–2.46), presence of ascites (aOR 1.88, 95% CI 1.44–2.46), older age (aOR 1.23, 95% CI 1.13–1.35), platelet count >400,000/mm3 (aOR 1.74, 95% CI 1.29–2.35), preoperative blood transfusion (aOR 11.00, 95% CI 1.28–94.77), disseminated cancer (aOR 1.28, 95% CI 1.03–1.60), increased length of operation (121–180 min, aOR 1.47, 95% CI 1.13-1.91; >180 min, aOR 2.78, 95% CI 2.13–3.64), and postoperative blood transfusion within 72 h of incision (aOR 2.04, 95% CI 1.59–2.62) (p < 0.05 for all). Conclusions: Longer length of hospital stay following surgery for OC is associated with many patient, disease, and treatment-related factors. The extent of surgery, as evidenced by perioperative blood transfusion and length of surgical procedure, is a factor that can potentially be modified to shorten LOS, improve patient outcomes, and reduce hospital costs.

Trends in extent of surgical cytoreduction for patients with ovarian cancer

“…ECR is associated with a postoperative mortality of approximately 1.8%, which corresponds with our findings [ 29 , 30 ]. Similarly, the increased length of stay and corresponding higher cost of hospitalization for patients with ECR has been associated with the dissemination of disease, extent of surgery, and presence of comorbidities, consistent with our findings [ 31 ]. Gynecologic oncologists and stakeholders in the management of women with ovarian cancer must work to establish guidelines that require adherence and quality metrics that are measured in a national database similar to the National Surgical Quality Improvement Project (NSQIP).…”

The Influence of the Preoperative Status on the Risk of Postoperative Complications After Cytoreductive Surgery for Advanced-stage Ovarian Cancer

“…Among the comorbidities that impacted the rate of postoperative morbidity, the strongest influence was observed for chronic obstructive pulmonary disease, chronic heart failure, renal function impairment as well as obesity; however, the onset of the adjuvant chemotherapeutic protocol was not influenced by the apparition of postoperative complications (18). Another similar study conducted on this theme in the United States of America and published this year came to demonstrate that association of a higher rate of preoperative comorbidities, presence of ascites, increased age, higher number of platelets, necessity of administration of preoperative or postoperative transfusions as well as a higher length of surgery and disseminated lesions are associated with a more difficult postoperative evolution and an increased length of hospital in stay; in the meantime the authors underlined the fact that a longer period of hospital in stay can also increase patients morbidity as well as the overall costs (19).…”

“…In this context, the authors underlined the all these factors could be considered when evaluating a risk prediction model of severe complications after debulking surgery for advanced stage ovarian cancer (22). In another similar study which investigated the effect of these parameters on the postoperative complications the authors underlined the fact the ability to predict the risk of postoperative complications increased by 27.4% when the type of procedure was analysed, by 22% when the preoperative level of albumin was analysed, by 11% when age was analysed and by 4% when associated comorbidities were analysed (19).…”

Impact of COVID-19 Pandemic on Ovarian Cancer Management: Adjusting to the New Normal

“…OC debulking surgery can be complicated and require a considerable amount of time and a critical care support system. 37,38 Unfortunately, the COVID-19 pandemic has forced hospitals to postpone several elective surgeries, including many cancer surgeries, to secure the resources for the expected increase number of COVID-19 patients. 21,39,40 Hospitals are also trying to protect their current patients from getting infections from patient visitors.…”