Linda R Duska1, James J Java2, David E Cohn3, Robert A Burger4. 1. University of Virginia Health Systems, Division of Gynecology Oncology, P.O. Box 800712, Charlottesville, VA 22908, United States. Electronic address: lduska@virginia.edu. 2. NRG Oncology/Gynecologic Oncology Group, Statistics & Data Center, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, United States. Electronic address: james.j.java@gmail.com. 3. Division of Gynecologic Oncology, The Ohio State University College of Medicine, 320 West 10th Avenue, M210 Starling Loving Hall, Columbus OH 43210, United States. Electronic address: david.cohn@osumc.edu. 4. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, 3400 Civic Center Boulevard, SCTR 8-104 Philadelphia PA, United States. Electronic address: robert.burger@uphs.upenn.edu.
Abstract
BACKGROUND: Readmission within 30days is a measure of care quality. Ovarian cancer patients are at high risk for readmission, but specific risk factors are not defined. This study was designed to determine risk factors in patients with ovarian cancer receiving upfront surgery and chemotherapy. METHODS: The study population was enrolled to GOG 0218. Factors predictive of admission within 30days of a previous admission or 40days of cytoreductive surgery were investigated. Categorical variables were compared by Pearson chi-square test, continuous variables by Wilcoxon-Mann-Whitney test. A logistic regression model was used to evaluate independent prognostic factors and to estimate covariate-adjusted odds. All tests were two-tailed, α=0.05. RESULTS: Of 1873 patients, 197 (10.5%) were readmitted, with 59 experiencing >1 readmission. One-hundred-forty-four (73%) readmissions were post-operative (readmission rate 7.7%). Significant risk factors include: disease stage (stage 3 vs 4, p=0.008), suboptimal cytoreduction (36% vs 64%, p=0.001), ascites, (p=0.018), BMI (25.4 vs 27.6, p<0.001), poor PS (p<0.001), and higher baseline CA 125 (p=0.017). Patients readmitted within 40days of surgery had a significantly shorter interval from surgery to chemotherapy initiation (22 versus 32days, p<0.0001). Patients treated with bevacizumab had higher readmission rates in the case of patients with >1 readmission. On multivariate analysis, the odds of re-hospitalization increased with doubling of BMI (OR=1.81, 95% CI: 1.07-3.07) and PS of 2 (OR=2.05, 95% CI 1.21-3.48). CONCLUSION: Significant risk factors for readmission in ovarian cancer patients undergoing primary surgery and chemotherapy include stage, residual disease, ascites, high BMI and poor PS. Readmissions are most likely after the initial surgical procedure, a discrete period to target with a prospective intervention.
BACKGROUND: Readmission within 30days is a measure of care quality. Ovarian cancerpatients are at high risk for readmission, but specific risk factors are not defined. This study was designed to determine risk factors in patients with ovarian cancer receiving upfront surgery and chemotherapy. METHODS: The study population was enrolled to GOG 0218. Factors predictive of admission within 30days of a previous admission or 40days of cytoreductive surgery were investigated. Categorical variables were compared by Pearson chi-square test, continuous variables by Wilcoxon-Mann-Whitney test. A logistic regression model was used to evaluate independent prognostic factors and to estimate covariate-adjusted odds. All tests were two-tailed, α=0.05. RESULTS: Of 1873 patients, 197 (10.5%) were readmitted, with 59 experiencing >1 readmission. One-hundred-forty-four (73%) readmissions were post-operative (readmission rate 7.7%). Significant risk factors include: disease stage (stage 3 vs 4, p=0.008), suboptimal cytoreduction (36% vs 64%, p=0.001), ascites, (p=0.018), BMI (25.4 vs 27.6, p<0.001), poor PS (p<0.001), and higher baseline CA 125 (p=0.017). Patients readmitted within 40days of surgery had a significantly shorter interval from surgery to chemotherapy initiation (22 versus 32days, p<0.0001). Patients treated with bevacizumab had higher readmission rates in the case of patients with >1 readmission. On multivariate analysis, the odds of re-hospitalization increased with doubling of BMI (OR=1.81, 95% CI: 1.07-3.07) and PS of 2 (OR=2.05, 95% CI 1.21-3.48). CONCLUSION: Significant risk factors for readmission in ovarian cancerpatients undergoing primary surgery and chemotherapy include stage, residual disease, ascites, high BMI and poor PS. Readmissions are most likely after the initial surgical procedure, a discrete period to target with a prospective intervention.
Authors: Michael T Kassin; Rachel M Owen; Sebastian D Perez; Ira Leeds; James C Cox; Kurt Schnier; Vjollca Sadiraj; John F Sweeney Journal: J Am Coll Surg Date: 2012-06-21 Impact factor: 6.113
Authors: Eric B Schneider; Omar Hyder; Benjamin S Brooke; Jonathan Efron; John L Cameron; Barish H Edil; Richard D Schulick; Michael A Choti; Christopher L Wolfgang; Timothy M Pawlik Journal: J Am Coll Surg Date: 2012-01-29 Impact factor: 6.113
Authors: Elizabeth C Wick; Andrew D Shore; Kenzo Hirose; Andrew M Ibrahim; Susan L Gearhart; Jonathan Efron; Jonathan P Weiner; Martin A Makary Journal: Dis Colon Rectum Date: 2011-12 Impact factor: 4.585
Authors: Robert A Burger; Mark F Brady; Michael A Bookman; Gini F Fleming; Bradley J Monk; Helen Huang; Robert S Mannel; Howard D Homesley; Jeffrey Fowler; Benjamin E Greer; Matthew Boente; Michael J Birrer; Sharon X Liang Journal: N Engl J Med Date: 2011-12-29 Impact factor: 91.245
Authors: Madeleine Courtney-Brooks; A Rauda Tellawi; Jennifer Scalici; Linda R Duska; Amir A Jazaeri; Susan C Modesitt; Leigh A Cantrell Journal: Gynecol Oncol Date: 2012-04-19 Impact factor: 5.482
Authors: Luigi Carlo Turco; Gabriella Ferrandina; Virginia Vargiu; Serena Cappuccio; Anna Fagotti; Giuseppina Sallustio; Giovanni Scambia; Francesco Cosentino Journal: Ann Transl Med Date: 2020-12
Authors: Stephanie Stelten; Christelle Schofield; Yvonne A W Hartman; Pedro Lopez; Gemma G Kenter; Robert U Newton; Daniel A Galvão; Meeke Hoedjes; Dennis R Taaffe; Luc R C W van Lonkhuijzen; Carolyn McIntyre; Laurien M Buffart Journal: Cancers (Basel) Date: 2022-09-20 Impact factor: 6.575