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Readmission Following Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Peritoneal Carcinomatosis — Can WE Predict (or Avoid) Them?
Alexander S. Martin*1, Daniel E. Abbott2, Dennis J. Hanseman2, Jonathan E. Sussman2, Alexander Kenkel2, Richard P. Greiwe2, Noor Saeed2, Samar Ahmad2, Jeffrey Sussman2, Syed Ahmad2
1Department of Surgical Oncology, University of Cincinnati, Cincinnati, OH; 2University of Cincinnati, Cincinnati, OH
Purpose: CRS/HIPEC for peritoneal carcinomatosis is a morbid endeavor. Despite improvement in perioperative management of these patients, there are subsets of patients requiring hospital readmission after discharge. Because the current health care climate demands an understanding of causative or explanatory factors of readmission, we sought to identify variables associated with readmission rates for CRS/HIPEC.
Methods: We conducted a retrospective review of CRS/HIPEC cases at a single institution between 1999 and 2014. Patient, tumor and treatment specific characteristics including completeness of cytoreduction (CCR), length of surgery, estimated blood loss (EBL), peritoneal cancer index (PCI), postoperative complications, length of hospital stay, readmission rates, length of readmission hospital stay, and reasons for readmission were included in the final dataset. Univariate analyses were used to understand the association between patient and outcome-specific variables and 7, 30 and 90-day readmission.
Results: Of 215 CRS/HIPEC patients, the 7, 30 and 90 day readmission rates were 9.8% (n=21), 14.9% (n=32), and 21.4% (n=46) respectively. The most common reasons for 30-day readmission included abdominal pain (n = 14), intra-abdominal abscess (n = 9), malnutrition/failure to thrive (n = 8), bowel obstruction (n = 7), and fever (n = 5). The primary factor associated with readmission at all time points (7, 30 and 90 days) was presence of an enterocutaneous fistula (ECF, p<0.01). Six patients (2.8%) had multiple readmissions; 3 of these had ECF. 24 (11.2%) and 112 (52.1%) patients underwent small bowel and colon resections, respectively; the ECF rate for these populations was 8.3% and 4.5%. Factors not associated with higher admission rates included sex, age, race, EBL, pancreatectomy, liver resection, and postoperative complications of wound infection, line infection and thromboemboli.
Conclusions: In patients undergoing CRS/HIPEC, readmission was primarily associated with ECF and its attendant electrolyte/fluid abnormalities. Patients with ECF were also disproportionately readmitted multiple times. These data should inform clinicians about patients at high-risk for readmission after CRS/HIPEC, and encourage more comprehensive coordination of post-discharge planning and care for specific patient populations.
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