Risk Factors and Indications for 30-Day Readmission After Primary Surgery for Epithelial Ovarian Cancer

Abstract

Background To identify patients at risk for postoperative morbidities, we evaluated indications and factors associated with 30-day readmission after epithelial ovarian cancer surgery. Methods Patients undergoing primary surgery for epithelial ovarian cancer between January 2, 2003, and December 29, 2008, were evaluated. Univariable and multivariable logistic regression models were fit to identify factors associated with 30-day readmission. A parsimonious multivariable model was identified using backward and stepwise variable selection. Results In total, 324 (60.2%) patients were stage III and 91 (16.9%) were stage IV. Of all 538 eligible patients, 104 (19.3%) were readmitted within 30 days. Cytoreduction to no residual disease was achieved in 300 (55.8%) patients, and 167 (31.0%) had measurable disease (≤1 cm residual disease). The most common indications for readmission were surgical site infection (SSI; 21.2%), pleural effusion/ascites management (14.4%), and thromboembolic events (12.5%). Multivariate analysis identified American Society of Anesthesiologists score of 3 or higher (odds ratio, 1.85; 95% confidence interval, 1.18–2.89; P = 0.007), ascites [1.76 (1.11–2.81); P = 0.02], and postoperative complications during initial admission [grade 3–5 vs none, 2.47 (1.19–5.16); grade 1 vs none, 2.19 (0.98–4.85); grade 2 vs none, 1.28 (0.74–2.21); P = 0.048] to be independently associated with 30-day readmission (c-index = 0.625). Chronic obstructive pulmonary disease was the sole predictor of readmission for SSI (odds ratio, 3.92; 95% confidence interval, 1.07–4.33; P = 0.04). Conclusions Clinically significant risk factors for 30-day readmission include American Society of Anesthesiologists score of 3 or higher, ascites and postoperative complications at initial admission. The SSI and pleural effusions/ascites are common indications for readmission. Systems can be developed to predict patients needing outpatient management, improve care, and reduce costs.

The Frequency of Unplanned Rehospitalization and Associated Factors in Gyneoncology Patients: A Retrospective Study

“…Besides, the complications identified were cardiopulmonary with a rate of 14.3%, infection with 11.7%, ileus with 11.1%, bleeding with 2.8%, and reoperation with 5.2%. In the study conducted by Alhilli et al, 17 it was identified that the presence of postoperative complications during the initial hospitalization increased significantly, and it was encountered 3 times more frequently with rehospitalization. In this context, the result of this study can be stated to be compliant with the studies in literature.…”

“…In a study conducted on patients with gynecological cancer by Henretta et al, 15 the population of the study was 324 women with gynecological cancer, and the rate of rehospitalization was 13.2%; in the study of Fauci et al, 16 the population for the study was 207 women with ovarian cancer who underwent surgery, and the rate of rehospitalization was 16.0%. In the study conducted by Alhilli et al, 17 where the patient population was 324 women who have epithelial ovarian cancer, the rate of rehospitalization was 19.3%. Contrary to these findings, the percentage of rehospitalization of patients was 80% in the study conducted by Jaramillo-Gonzalez et al, 18 and higher rates were also reported in other studies.…”

“…In the study conducted by Henretta et al, 15 it was concluded that the causes of rehospitalization was, respectively, as gastrointestinal (40.7%), chemotherapy (12.6%), infection (15.5%), pain (8.7%), and pulmonary (5.8%). In a case study conducted by Alhilli et al, 17 the most common indicators for rehospitalization were surgical site infection (21.2%), pleural effusion/ascites management (14.4%), and thromboembolic events (12.5%). While searching for the possible indicators for Factors that caused rehospitalization were classified as the factors relevant to patient, disease, and medical systems.…”

“…17,20,22,24 In the study conducted by Alhilli et al, 17 it was seen that patients undergoing rehospitalizations experienced more than 1 series admission. Those patients were diagnosed with ovarian cancer with a rate of 57%, cervix with 30%, and uterus with 11%.…”

“…In addition, in the studies, it was found that poor communication with patient, inadequate outpatient visits, and discharge without counseling the patient and her family about expectations and the possible complications of the operations underwent were among the causes for rehospitalization. 16,17,28,33,34 Hospitals and physicians may need to collaborate to improve the promptness and reliability of follow-up care. Thus, health providers should focus to model teamwork and communication by using created a precedent for changing health care.…”