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Peritoneal Surface Malignancies

E339: Predicting 90-Day Readmissions Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Nested Case-Control Study

Introduction: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) can be associated with a prolonged postoperative course, necessitating readmissions. We aimed to identify predictors and reasons of readmissions after CRS/HIPEC.

Methods: In a nested case-control study using a prospective institutional CRS/HIPEC database (2/2006-6/2023), we defined cases as patients with unscheduled readmission within 90 days after discharge and controls as patients free of readmissions. Patients with aborted HIPEC, deaths during initial hospital stay, loss to follow-up, or missing data were excluded. Perioperative variables were compared. Complications were graded with the Clavien-Dindo Classification (CDC). To identify predictors for readmission and death, we employed a multivariate logistic regression with adaptive Lasso model selection and cross-validation on an unseen subset (25%).

Results: Of 940 CRS/HIPECs, 860 were eligible (239 cases and 621 controls) with an overall 90-day readmission rate of 27.8% (239/860) and mortality of 2.6% (n=22/860). Cases and controls were balanced by sex and primary tumor site (appendix: n=433, 50.3%, ovarian: n=200, 23.2%, colon: n=116, 13.5%, and other: n=113, 12.9%). Cases were older (mean ± SD age: 58.0±11.5 vs 55.7±12.1 years, p=0.012) and more likely to have depression (18.0% vs 10.1%, p=0.002). Cases had a higher tumor burden (peritoneal cancer index ≥20: 66.9% vs 53.3%, p< 0.001), longer surgery time (median [IQR]: 545 [455, 660] vs 508 [400, 607] minutes, p=0.002) and initial hospital stay (median [IQR]: 10 [8, 14] vs 9 [8, 12] days, p< 0.001), higher rates of grade III-IV complications before discharge (28.2% vs 9.3%, p< 0.001), and discharge on parenteral nutrition (7.1% vs 2.3%, p< 0.001). Failure to thrive (FTT) or dehydration was the main cause of readmission (109/239, 45.6%), followed by abdominal infection (54/239, 22.6%) and ileus or small bowel obstruction (52/239, 21.8%). The predictive model for readmissions (area under ROC=0.72), adjusted for place of residency, age, depression, history of prior CRS/HIPEC, and bowel anastomosis, was significant for early hematological and renal complications, severe predischarge dehydration and venous thromboembolic events (VTE), and discharge with leukocytosis and sodium < 135 mEq/L (Figure 1).

Conclusions: Certain predischarge complications, including severe postoperative anemia, dehydration, or VTE, and discharge with hyponatremia or leukocytosis were strong predictors of 90-day readmission after CRS/HIPEC.

Learning Objectives:

  • To describe key perioperative characteristics for patients who did or did not experience readmission after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.
  • To evaluate key reasons for readmission after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.
  • To build a predictive model for 90-day readmission after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy with a focus on events occurring within initial hospital stay.