Factors Associated With 60-Day Readmission Following Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy

Ann Surg Oncol. 2018 Jan;25(1):91-97. doi: 10.1245/s10434-017-6108-8. Epub 2017 Oct 31.

Abstract

Introduction: Readmission rates following surgery are subject to scrutiny in efforts to control health care costs. This study was designed to define the 60-day readmission rate following cytoreduction and HIPEC at a high-volume center and to identify factors associated with readmission.

Methods: Patients who underwent complete cytoreduction and HIPEC at a single institution from August 2007 through June 2014 were identified from a prospectively maintained database. Multiple preoperative and operative factors were analyzed for their ability to predict 60-day readmission following surgery.

Results: A total of 250 patients were identified. Forty patients (17%) experienced readmission within 60 days of surgery. The most common reasons for readmission were ileus/dehydration (12, 31%), deep space infection (8, 21%), and DVT/PE (6, 15%). Initial postoperative length of stay was longer for patients readmitted within 60 days (median 12 vs. 9 days, p = 0.013). Of categorical variables analyzed, including gender, histology, HIPEC agent, intraoperative transfusion, and individual procedures performed during cytoreduction, adjuvant systemic therapy, and postoperative morbidity, only Charlson comorbidity index CCI (odds ratio (OR) = 3.80 [1.68-8.60]) and stoma creation (OR = 6.04 [1.56-12.14]) were associated with 60-day readmission.

Conclusions: Few measurable variables are associated with readmission following cytoreduction and HIPEC. Patients with high CCI and those with stomas created at the time of CRS/HIPEC may be at increased risk of readmission within 60 days. Earlier or more frequent follow-up for high-risk patients should be considered as a strategy to reduce readmissions.

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / administration & dosage
  • Carcinoma / secondary
  • Carcinoma / therapy*
  • Comorbidity
  • Cytoreduction Surgical Procedures / adverse effects*
  • Dehydration / etiology
  • Female
  • Humans
  • Hyperthermia, Induced / adverse effects*
  • Ileus / etiology
  • Infections / etiology
  • Length of Stay
  • Male
  • Middle Aged
  • Ostomy / adverse effects
  • Patient Readmission / statistics & numerical data*
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / therapy*
  • Postoperative Complications / etiology*
  • Pulmonary Embolism / etiology
  • Retrospective Studies
  • Risk Factors
  • Venous Thrombosis / etiology
  • Young Adult

Substances

  • Antineoplastic Agents