Predictors of Readmission After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Risk factors for hospital readmission after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are poorly understood.

The American College of Surgeons-National Surgical Quality Improvement Program databases from 2011 to 2016 were used to identify all patients who underwent CRS-HIPEC. Demographic, clinical, and perioperative variables were examined using logistic regression to identify factors associated with 30-d postoperative readmission.

Among 618 patients who underwent CRS-HIPEC, 96 (15.5%) required hospital readmission within 30 d of surgery. The incidence of readmission decreased over the study period (18.3% in 2011 to 4.8% in 2016). Among the 59 patients who were readmitted and had complete data available, readmission occurred on mean postoperative day 18.5 ± 5.5; the most common reasons for readmission were digestive complications (39.0%), postoperative infections (25.4%), uncontrolled pain (8.5%), and venous thromboembolism (5.1%). On multivariate logistic regression analysis, increasing age (OR 1.02, 95% CI 1.00-1.05), number of operative procedures (OR 1.12, 95% CI 1.00-1.25), perioperative complication (OR 7.06, 95% CI 3.96-12.59), need for reoperation (OR 10.21, 95% CI 3.50-29.83), and length of stay (OR 0.93, 0.90-0.97) were associated with hospital readmission.

In this population-based analysis of patients undergoing CRS-HIPEC, older age, perioperative complications, need for reoperation, and extent of cytoreduction were associated with hospital readmission. The American College of Surgeons-National Surgical Quality Improvement Program database is a powerful research tool that can be used to identify opportunities to improve the perioperative care of surgical patients.