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  • Beyond post-operative readmissions: analysis of the impact of unplanned readmissions during primary treatment of advanced-stage epithelial ovarian cancer on long-term oncology outcome

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Original research
Beyond post-operative readmissions: analysis of the impact of unplanned readmissions during primary treatment of advanced-stage epithelial ovarian cancer on long-term oncology outcome
  1. Dandi Huang1,2,
  2. Ross Harrison3,
  3. Erin Curtis4,5,
  4. Nina Mirabadi4,6,
  5. Grace Yi Chen7,
  6. Roxana Alexandridis7,
  7. Lisa Barroilhet8,
  8. Stephen Rose8,
  9. Ellen Hartenbach8 and
  10. Ahmed Al-Niami8
  1. 1 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
  2. 2 Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  3. 3 Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
  4. 4 University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  5. 5 Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
  6. 6 Department of General Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  7. 7 Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  8. 8 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  1. Correspondence to Dr Dandi Huang, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; dandihuang21{at}gmail.com

Abstract

Background Multiple studies have assessed post-operative readmissions in advanced ovarian cancer.

Objective To evaluate all unplanned readmissions during the primary treatment period of advanced epithelial ovarian cancer, and the impact of readmission on progression-free survival.

Methods This was a single institution retrospective study from January 2008 to October 2018. Χ2/Fisher’s exact and t-test, or Kruskal-Wallis test were used. Multivariable Cox proportional hazard models were used to assess the effect of covariates in progression-free survival analysis.

Results A total of 484 patients (279 primary cytoreductive surgery, 205 neoadjuvant chemotherapy) were analyzed. In total, 272 of 484 (56%; 37% primary cytoreductive surgery, 32% neoadjuvant chemotherapy, p=0.29) patients were readmitted during the primary treatment period. Overall, 42.3% of the readmissions were surgery related, 47.8% were chemotherapy related, and 59.6% were cancer related but not related to surgery or chemotherapy, and each readmission could qualify for more than one reason. Readmitted patients had a higher rate of chronic kidney disease (4.1% vs 1.0%, p=0.038). Post-operative, chemotherapy, and cancer-related readmissions were similar between the two groups. However, the percentage of inpatient treatment days due to unplanned readmission was twice as high for primary cytoreductive surgery at 2.2% vs 1.3% for neoadjuvant chemotherapy (p<0.001). Despite longer readmissions in the primary cytoreductive surgery group, Cox regression analysis demonstrated that readmissions did not affect progression-free survival (HR=1.22, 95% CI 0.98 to 1.51; p=0.08). Primary cytoreductive surgery, higher modified Frailty Index, grade 3 disease, and optimal cytoreduction were associated with longer progression-free survival.

Conclusions In this study, 35% of the women with advanced ovarian cancer had at least one unplanned readmission during the entire treatment time. Patients treated by primary cytoreductive surgery spent more days during readmission than those with neoadjuvant chemotherapy. Readmissions did not affect progression-free survival and may not be valuable as a quality metric.

  • ovarian neoplasms
  • postoperative period

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

http://dx.doi.org/10.1136/ijgc-2022-003765

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    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Twitter @rossfh

    • EC and NM contributed equally.

    • Contributors DH: project conceptualization, chart review, manuscript preparation, gurantor; RH: chart review and manuscript review; EC, NM: chart review; GYC, RA: statistical analysis; LB, SR: overall project guidance, manuscript review; EH: manuscript review; AA-N: overall project guidance, statistical analysis, manuscript review.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.