title: Patient, treatment and discharge factors associated with hospital readmission within 30 days after surgical cytoreduction for epithelial ovarian carcinoma.
abstract: OBJECTIVE
  Hospital readmissions are common, costly and increasingly viewed as adverse events. In gynecologic oncology, data on readmissions are limited. The goal of this study was to examine the patient, treatment and discharge factors associated with unplanned readmission after cytoreductive surgery.
  
  
  METHODS
  We identified all patients with stages II-IV ovarian cancer who underwent surgical cytoreduction at our institution between 2003 and 2011. A retrospective chart review was performed, and clinical variables were extracted. Utilizing linear and logistic regression, these clinical variables were correlated with risk of readmission.
  
  
  RESULTS
  A total of 460 patients were included in the analysis, with the majority having a stage IIIC high grade serous cancer. Optimal cytoreduction (<1.0 cm residual disease) was obtained in 368 patients (81%), and 233 patients (50%) underwent at least one radical procedure. Perioperative complications were observed in 148 patients (32%). A large proportion of our cohort was discharged to rehabilitation facilities (12%) or with a visiting nurse (38%). Fifty five patients (12%) were readmitted within 30 days. On multivariate logistic regression, reoperation and perioperative cardiopulmonary event were the only factors associated with readmission (OR=3.2, 95% CI=1.7-6.0). Discharge home with ancillary services was not protective against readmission, even when controlling for perioperative complications (OR=1.18, 95% CI=0.53-2.64).
  
  
  CONCLUSIONS
  Readmission after surgical cytoreduction affected 12% of our population. Multivariate analyses suggested perioperative complications, particularly reoperation and cardiopulmonary event, placed the patient at the greatest risk. Age, comorbidities, surgical radicality and discharge with visiting nurse services/rehabilitation facility did not affect the likelihood of readmission.
authors.affiliation: Division of Gynecologic Oncology, Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA 02114, United States. rmclark@partners.org
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Clark
authors.forename: Whitfield B
authors.initials: WB
authors.lastname: Growdon
authors.forename: Andrew
authors.initials: A
authors.lastname: Wiechert
authors.forename: David
authors.initials: D
authors.lastname: Boruta
authors.forename: Marcela
authors.initials: M
authors.lastname: Del Carmen
authors.forename: Anne Kathryn
authors.initials: AK
authors.lastname: Goodman
authors.forename: Leslie
authors.initials: L
authors.lastname: Bradford
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rauh-Hain
authors.forename: John O
authors.initials: JO
authors.lastname: Schorge
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000601:surgery*; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D045823:Ileus / Q000209:etiology; D007902:Length of Stay; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology* / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery*; D010351:Patient Discharge; D010359:Patient Readmission / Q000191:economics; D059035:Perioperative Period; D010996:Pleural Effusion / Q000209:etiology; D011655:Pulmonary Embolism / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors
keywords: Cytoreduction; Outcomes; Quality; Readmission