Predictors of 30-day Readmission among Ovarian Cancer Patients Undergoing Surgery
Author(s): Rachel L Budker, Sarah E Rudasill, Alexandra L Mardock, Natsai C Nyakudarika, Peyman Benharash, Joshua G Cohen
Background: Cytoreductive surgery in ovarian cancer remains a complex and invasive procedure with elevated risks of postoperative complications and readmission. We aimed to characterize the rate and predictors of 30-day readmission in patients undergoing ovarian cancer surgery.
Methods: Women undergoing ovarian cancer surgery between 2010 and 2015 were identified in the Nationwide Readmissions Database (NRD). Baseline demographics and clinical features of patients readmitted within 30 days were analyzed. Multivariable logistic regression analysis was used to identify significant perioperative factors associated with readmission.
Results: Of 94,077 patients undergoing surgery for ovarian malignancy, 12,806 (13.6%) were readmitted within 30 days. The proportion of 30-day readmissions has significantly decreased from 15.2% in 2010 to 12.5% in 2015 (p<.001). Readmitted patients were more likely to have large bowel resection during initial surgery (18.9 vs. 11.5%, p<.001), and experience a postoperative complication, including bowel perforation and infection (11.2 vs. 7.7%, p<.001). The primary reasons for 30-day readmission included postoperative infection (10.6%) and gastrointestinal dysfunction or infection (9.0%). In multivariable analysis, Medicaid (OR 1.18 [95% Confidence Interval 1.04-1.35]), age < 50 years old (OR 1.35 [1.17-1.56]), large (OR 1.35 [1.20-1.51]) or small bowel (OR 1.34 [1.14-1.57]) resection, and discharge to a skilled nursing facility (SNF; OR 1.53 [1.34-1.75]) were significantly associated with 30-day readmission. For readmitted patients, index hospitalization cost was higher ($25,021 vs. $19,587, p<.001) and length of stay (LOS) was longer (8.7 vs 6.4 days, p<.001).
Discussion: Rates of 30-day readmission are declining, however, continued optimization of perioperative pathways for patients at highest risk of readmission, including those undergoing bowel resections and those discharged to a SNF, is warranted.