Risk factors and indications for 30-day readmission after primary surgery for epithelial ovarian cancer

Mariam AlHilli, Carrie Langstraat, Christine Tran, Janice Martin, Amy Weaver, Michaela McGree, Andrea Mariani, William Cliby, Jamie Bakkum-Gamez

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Background: To identify patients at risk for postoperative morbidities, we evaluated indications and factors associatedwith 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 readmissionwere surgical site infection (SSI; 21.2%), pleural effusion/ascites management (14.4%), and thromboembolic events (12.5%). Multivariate analysis identifiedAmerican 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 associatedwith 30-day readmission (c-index = 0.625). Chronic obstructive pulmonary diseasewas 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.

Original languageEnglish (US)
Pages (from-to)193-202
Number of pages10
JournalInternational Journal of Gynecological Cancer
Volume25
Issue number2
DOIs
StatePublished - Feb 1 2015

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Keywords

  • Ovarian cancer
  • Primary cytoreduction
  • Readmission

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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