Factors associated with emergency room readmission after elective surgery for ovarian carcinoma

Salcedo-Hernandez et al. BMC Women's Health https://doi.org/10.1186/s12905-023-02579-7 (2023) 23:473 BMC Women's Health Open Access RESEARCH Factors associated with emergency room readmission after elective surgery for ovarian carcinoma Rosa A. Salcedo-Hernandez1,2*, Salim Barquet-Muñoz2, David Isla-Ortiz2,7, Florencia Lucero-Serrano2, Leonardo S. Lino-Silva3, David Cantú de León4,7* and Lucely Cetina-Perez5,6* Abstract Background Hospital readmission is a quality metric of hospital care and has been studied in ovarian carcinoma, but its evaluation has several limitations. Also, emergency room (ER) readmission is considered an adverse effect because it represents patient costs. Therefore, our objective was to determine the rate of ER readmission, its causes, and associated factors. Methods A retrospective study of 592 patients with ovarian carcinoma who underwent upfront surgery, neoadjuvant therapy, or surgery for recurrent disease. An analysis of factors associated with ER readmission, hospital readmission, and surgical complications was performed, including multivariate analysis to assess for case-mix factors. Results Of 592 patients, the median age was 51 years, and the predominant type of treatment was the neoadjuvant approach (52.9%); 46% underwent upfront surgeries and six surgeries for recurrence. The ratio to ER readmission was 11.8% (70 patients), of whom 12 patients were admitted more than once. The factors associated with ER readmission were prolonged surgery, intraoperative bleeding, extended hospital stay, the time of the day when the surgery was performed, and post-surgical complications. The hospital readmissions were 4.2%, and the overall morbidity was 17.6%. In the multivariate analysis, the only factor associated with ER readmission was the presence of surgical complications (OR = 39.01). The factors independently associated with hospital readmission were the entrance to the intensive care unit (OR = 1.37), the presence of surgical complications (OR = 2.85), and ER readmission (OR = 1.45). Conclusion ER readmission is an adverse event representing the presence of symptoms/complications in patients. Evaluating the ER readmission independently of the readmission to the hospital is critical because it will allow modifying medical care behaviors to prevent patients from unnecessarily returning to the hospital after a hospital discharge to manage preventable medical problems. Trial registration researchregistry7882. *Correspondence: Rosa A. Salcedo-Hernandez Lucely Cetina-Perez Full list of author information is available at the end of the article © The Author(s) 2023. 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The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Salcedo-Hernandez et al. BMC Women's Health (2023) 23:473 Page 2 of 8 Highlights • Emergency room readmission is an adverse effect of ovarian carcinoma and represents health system costs. • Readmission was associated with prolonged surgery, intraoperative bleeding, extended hospital stays, and surgeries performed in the afternoon. • Emergency room readmission is strongly associated with hospital readmission. • Rosa A. Salcedo-Hernandez, David Cantú-de León and Lucely Cetina-Perez have contributed equally to the present study. Keywords Ovarian carcinoma, Surgery, Emergency room, Complications Background Ovarian carcinoma is considered a public health problem; according to Globocan 2020, it is ranked eighth in incidence and mortality in women [1]. Treatment for ovarian carcinoma is multidisciplinary, and the surgery is integral to the treatment, either from the beginning or during the disease course [2]. International organizations have developed indicators to measure the quality of surgeries, including the systematic recording of complications as an outcome indicator [3]. Hospital readmission has been considered a quality metric of hospital care. It has been a focus of interest for a long time, and in the United States, a program to reduce readmissions has been created and applied to several diseases [4, 5]. This indicator has been proposed to represent the quality of care for postoperative patients with ovarian carcinoma; however, it possesses disadvantages: (a) does not consider the type of population to which it is being applied (patients with advanced disease, fragile, etc.), (b) increase in readmissions can be due to the extension of surgery (in particular, during primary surgery) and, (c) the use of neoadjuvant chemotherapy can be inadvertently favored as the primary treatment in advanced stages to avoid the possible complications of extensive surgery and possible hospital readmissions [6, 7]. Emergency room (ER) readmission (does not mean hospital readmission because many patients attend ER services for several reasons: doubts about their care, mild pain, etc., which does not necessarily imply that the patient is hospitalized) is considered an adverse effect of medical care because it represents a return to the hospital due to the presence of symptoms or complications. This ER readmission means costs for patients regarding time, trips to/from the hospital, loss of work opportunities, and out-of-pocket expenses; it also is a burden for primary caregivers. In addition, it also represents an expense for the health system [8]. A 12% rate of ER readmission after surgery for gynecological cancer has been reported [8, 9]. The factors associated with hospital readmission – which could also be associated with ER readmission after discharge – are poor communication with the patient, insufficient follow-up after discharge, and lack of coordination between the different levels of hospital care [8]. However, there is no evidence in the literature regarding the associated factors and causes of ER readmission for postoperative patients with ovarian carcinoma; although factors associated with hospital readmission have been described, the factors for ER readmission could be different because hospitalization is not required for their resolution. (...truncated)