Readmissions after ovarian cancer cytoreduction surgery: The first 30 days and beyond

Mardock, Alexandra L.; Rudasill, Sarah; Lai, Tiffany; Sanaiha, Yas; Wong, Deanna H.; Sinno, Abdulrahman K.; Benharash, Peyman; Cohen, Joshua G.

doi:10.1002/jso.26137

Cited by 6 publications

(5 citation statements)

References 28 publications

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“…Hospital characteristics included teaching status, size, region, and urban or rural location. Hospitals were also categorized into tertiles based on operative volume using the annual number of endometrial cancer operations reported, as our group has implemented in prior database studies 17. Patients <18 years of age as well as those missing age, insurance, and survival data were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…The Elixhauser Comorbidity Index was used to assess the burden of chronic conditions. The Elixhauser Comorbidity Index algorithm uses ICD-9-CM and ICD-10-CM codes to identify 30 comorbidities thoroughly validated for use in administrative databases 17. Extended procedures were defined using methods previously published by Jones et al and encompassed any procedure involving concomitant resection of the stomach, spleen, liver, diaphragm, small or large bowel, or rectosigmoid colon, or any procedure resulting in ileostomy or colostomy 21…”

Section: Methodsmentioning

confidence: 99%

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Frailty is independently associated with worse outcomes and increased resource utilization following endometrial cancer surgery

Nakhla

Eakin

Mandelbaum

et al. 2022

Int J Gynecol Cancer

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ObjectiveFrailty has been associated with poorer surgical outcomes and is a critical factor in procedural risk assessment. The objective of this study is to assess the impact of frailty on surgical outcomes in patients with endometrial cancer.MethodsPatients undergoing inpatient gynecologic surgery for endometrial cancer were identified using the 2005–2017 Nationwide Inpatient Sample database. The Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator was used to designate frailty. Multivariate regression models were used to assess the association of frailty with postoperative outcomes and resource use.ResultsOf 339 846 patients, 2.9% (9868) were considered frail. After adjusting for patient and hospital characteristics, frailty was associated with a four-fold increase in inpatient mortality (adjusted OR (aOR) 4.1; p<0.001), non-home discharge (aOR 5.2; p<0.001), as well as increased respiratory (aOR 2.6; p<0.001), neurologic (aOR 3.3; p<0.001), renal (aOR 2.0; p<0.001), and infectious (aOR 3.2; p<0.001) complications. While frail patients exhibited increased mortality with age, the rate of mortality in this cohort decreased significantly over time. Compared with non-frail counterparts, frail patients had longer lengths of stay (7.6 vs 3.4 days; p<0.001) and increased hospitalization costs with surgical admission ($25 093 vs $13 405; p<0.001).ConclusionsFrailty is independently associated with worse surgical outcomes, including increased mortality and resource use, in women undergoing surgery for endometrial cancer. Though in recent years there have been improvements in mortality in the frail population, further efforts to mitigate the impact of frailty should be explored.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Frailty is independently associated with worse outcomes and increased resource utilization following endometrial cancer surgery

Nakhla

Eakin

Mandelbaum

et al. 2022

Int J Gynecol Cancer

Self Cite

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“…Modeled after previously published studies on postoperative outcomes in ovarian cancer surgery ( Wright et al, 2011 , Cham et al, 2019 , Kumar et al, 2016 ), the primary outcome was a 30-day morbidity composite, which included surgical complications (wound complication, intraperitoneal abscess, ileus, small bowel obstruction, bowel perforation, and reoperation within 30 days) and medical complications (venous thromboembolism, arrhythmia, myocardial infarction, pneumonia, cardiopulmonary arrest, and acute renal failure). Secondary outcomes were measures of increased healthcare utilization, including an extended hospital stay (defined as > 7 days) ( Mardock et al, 2020 ), intensive care unit admission, and 30-day hospital readmission; as well as progression-free and overall survival.…”

Section: Methodsmentioning

confidence: 99%

Community access to primary care is an important geographic disparity among ovarian cancer patients undergoing cytoreductive surgery

Zamorano

Mazul

Marx

et al. 2022

Gynecologic Oncology Reports

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“…Venous thromboembolism events that require readmission are associated with significant cost and have a high risk of mortality . The 30-day readmission rate after complex cancer surgery varies from 10% to 15%, with approximately 2% to 4% of readmissions attributed to VTE . Because patients undergoing complex cancer surgery remain at extended risk for VTE, it is likely that readmissions owing to VTE also continue beyond 30 days.…”

Section: Introductionmentioning

confidence: 99%

“…7,8 The 30-day readmission rate after complex cancer surgery varies from 10% to 15%, with approximately 2% to 4% of readmissions attributed to VTE. [9][10][11][12][13] Because patients undergoing complex cancer surgery remain at extended risk for VTE, it is likely that readmissions owing to VTE also continue beyond 30 days. These severe VTE events are a potentially preventable delayed complication after complex cancer surgery.…”

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confidence: 99%

Readmissions From Venous Thromboembolism After Complex Cancer Surgery

et al. 2022

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IMPORTANCE Venous thromboembolism (VTE) is a major cause of preventable morbidity and mortality after cancer surgery. Venous thromboembolism events that are significant enough to require hospital readmission are potentially life threatening, yet data regarding the frequency of these events beyond the 30-day postoperative period remain limited.OBJECTIVE To determine the rates, outcomes, and predictive factors of readmissions owing to VTE up to 180 days after complex cancer operations, using a national data set. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study of the 2016 Nationwide Readmissions Database was performed to study adult patients readmitted with a primary VTE diagnosis. Data obtained from 197 510 visits for 126 104 patients were analyzed. This was a multicenter, population-based, nationally representative study of patients who underwent a complex cancer operation (defined as cystectomy, colectomy, esophagectomy, gastrectomy, liver/biliary resection, lung/bronchus resection, pancreatectomy, proctectomy, prostatectomy, or hysterectomy) from January 1 through September 30, 2016, for a corresponding cancer diagnosis. EXPOSURES Readmission with a primary diagnosis of VTE.MAIN OUTCOMES AND MEASURES Proportion of 30-, 90-, and 180-day VTE readmissions after complex cancer surgery, factors associated with readmissions, and outcomes observed during readmission visit, including mortality, length of stay, hospital cost, and readmission to index vs nonindex hospital. RESULTSFor the 126 104 patients included in the study, 30-, 90-, and 180-day VTE-associated readmission rates were 0.6% (767 patients), 1.1% (1331 patients), and 1.7% (1449 of 83 337 patients), respectively. A majority of patients were men (58.7%), and the mean age was 65 years (SD, 11.5 years). For the 1331 patients readmitted for VTE within 90 days, 456 initial readmissions (34.3%) were to a different hospital than the index surgery hospital, median length of stay was 5 days (IQR, 3-7 days), median cost was $8102 (IQR, $5311-$10 982), and 122 patients died (9.2%). Independent factors associated with readmission included type of operation, scores for severity and risk of mortality, age of 75 to 84 years (odds ratio [OR], 1.30; 95% CI, 1.02-1.78), female sex (OR, 1.23; 95% CI,, nonelective index admission (OR, 1.31; 95% CI, 1.03-1.68), higher number of comorbidities (OR, 1.30; 95% CI, 1.06-1.60), and experiencing a major postoperative complication during the index admission (OR, 2.08; 95% CI, 1.85-2.33). CONCLUSIONS AND RELEVANCEIn this cohort study, VTE-related readmissions after complex cancer surgery continued to increase well beyond 30 days after surgery. Quality improvement efforts to decrease the burden of VTE in postoperative patients should measure and account for these late VTE-related readmissions.

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Readmissions after ovarian cancer cytoreduction surgery: The first 30 days and beyond

Cited by 6 publications

References 28 publications

Frailty is independently associated with worse outcomes and increased resource utilization following endometrial cancer surgery

Frailty is independently associated with worse outcomes and increased resource utilization following endometrial cancer surgery

Community access to primary care is an important geographic disparity among ovarian cancer patients undergoing cytoreductive surgery

Readmissions From Venous Thromboembolism After Complex Cancer Surgery

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