TY - JOUR
T1 - Risk factors and indications for 30-day readmission after primary surgery for epithelial ovarian cancer
AU - AlHilli, Mariam
AU - Langstraat, Carrie
AU - Tran, Christine
AU - Martin, Janice
AU - Weaver, Amy
AU - McGree, Michaela
AU - Mariani, Andrea
AU - Cliby, William
AU - Bakkum-Gamez, Jamie
N1 - Publisher Copyright:
Copyright © 2015 by IGCS and ESGO.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - 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.
AB - 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.
KW - Ovarian cancer
KW - Primary cytoreduction
KW - Readmission
UR - http://www.scopus.com/inward/record.url?scp=84925882367&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84925882367&partnerID=8YFLogxK
U2 - 10.1097/IGC.0000000000000339
DO - 10.1097/IGC.0000000000000339
M3 - Article
C2 - 25611896
AN - SCOPUS:84925882367
SN - 1048-891X
VL - 25
SP - 193
EP - 202
JO - International Journal of Gynecological Cancer
JF - International Journal of Gynecological Cancer
IS - 2
ER -