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Clinical Factors Associated with Longer Hospital Stay Following Ovarian Cancer Surgery

1
Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536-0293, USA
2
Department of Surgery, University of Kentucky, Lexington, KY 40536-0293, USA
3
Division of Gynecologic Oncology, Markey Cancer Center, University of Kentucky, Lexington, KY 40536-0293, USA
*
Author to whom correspondence should be addressed.
Healthcare 2019, 7(3), 85; https://doi.org/10.3390/healthcare7030085
Received: 4 June 2019 / Revised: 23 June 2019 / Accepted: 24 June 2019 / Published: 3 July 2019
(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)
Background: Ovarian cancer (OC) is the leading cause of death from gynecologic malignancy and is treated with a combination of cytoreductive surgery and platinum-based chemotherapy. Extended length of stay (LOS) after surgery can affect patient morbidity, overall costs, and hospital resource utilization. The primary objective of this study was to identify factors contributing to prolonged LOS for women undergoing surgery for ovarian cancer. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify women from 2012–2016 who underwent hysterectomy for ovarian, fallopian tube and peritoneal cancer. The primary outcome was LOS >50th percentile. Preoperative and intraoperative variables were examined to determine which were associated with prolonged LOS. Results: From 2012–2016, 1771 women underwent elective abdominal surgery for OC and were entered in the ACS-NSQIP database. The mean and median LOS was 4.6 and 4.0 days (IQR 0–38), respectively. On multivariate analysis, factors associated with prolonged LOS included: American Society of Anesthesiologists (ASA) Classification III (aOR 1.71, 95% CI 1.38–2.13) or IV (aOR 1.88, 95% CI 1.44–2.46), presence of ascites (aOR 1.88, 95% CI 1.44–2.46), older age (aOR 1.23, 95% CI 1.13–1.35), platelet count >400,000/mm3 (aOR 1.74, 95% CI 1.29–2.35), preoperative blood transfusion (aOR 11.00, 95% CI 1.28–94.77), disseminated cancer (aOR 1.28, 95% CI 1.03–1.60), increased length of operation (121–180 min, aOR 1.47, 95% CI 1.13-1.91; >180 min, aOR 2.78, 95% CI 2.13–3.64), and postoperative blood transfusion within 72 h of incision (aOR 2.04, 95% CI 1.59–2.62) (p < 0.05 for all). Conclusions: Longer length of hospital stay following surgery for OC is associated with many patient, disease, and treatment-related factors. The extent of surgery, as evidenced by perioperative blood transfusion and length of surgical procedure, is a factor that can potentially be modified to shorten LOS, improve patient outcomes, and reduce hospital costs. View Full-Text
Keywords: ovarian cancer; length of stay; ACS-NSQIP; blood transfusion; neoadjuvant chemotherapy; interval debulking surgery; primary cytoreductive surgery ovarian cancer; length of stay; ACS-NSQIP; blood transfusion; neoadjuvant chemotherapy; interval debulking surgery; primary cytoreductive surgery
MDPI and ACS Style

Smith, C.G.; Davenport, D.L.; Gorski, J.; McDowell, A.; Burgess, B.T.; Fredericks, T.I.; Baldwin, L.A.; Miller, R.W.; DeSimone, C.P.; Dietrich, C.S., III; Gallion, H.H.; Pavlik, E.J.; van Nagell, J.R., Jr.; Ueland, F.R. Clinical Factors Associated with Longer Hospital Stay Following Ovarian Cancer Surgery. Healthcare 2019, 7, 85.

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