Evaluating unplanned readmission and prolonged length of stay following minimally invasive surgery for endometrial cancer

Objective: To evaluate risk factors for 30-day unplanned readmission and increased length of stay (LOS) following minimally invasive surgery (MIS) for endometrial cancer. Methods: This was a retrospective, case-control study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). Multivariable logistic regression was used to assess perioperative variables associated with readmission and increased LOS after MIS for endometrial cancer. Results: The study population included 10,840 patients who met the criteria of having undergone MIS with a resultant endometrial malignancy confirmed on postoperative pathology. Common reasons for readmission included organ/space surgical site infection (65 cases), sepsis/septic shock (19 cases), and venous thromboembolism (20 cases). Notable risk factors for readmission included (Odds Ratio, Confidence Interval, p-value): dialysis dependence (6.77, 2.51–17.80, <0.01), increased length of stay (3.00, 2.10–4.10, <0.01), and preoperative weight loss (2.80, 1.06–7.17, 0.03); notable risk factors for increased LOS: ascites (8.51, 2.00–36.33, <0.01), operation duration >5 h (6.93, 5.29–9.25, <0.01), and preoperative blood transfusion (5.37, 2.05–14.04, <0.01). Conclusions: Identification of risk factors for adverse postoperative outcomes is necessary to inform and improve standards of care in MIS for endometrial cancer. Using nationally reported data from the ACS NSQIP, this study identifies independent risk factors for unplanned readmission and prolonged LOS, and in doing so, highlights potential avenues for quality improvement.