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Effect of frailty on postoperative readmissions and cost of care for ovarian cancer

Published: November 1, 2020
Category: Bibliography
Authors: Alexander M. Friedman, Jason D. Wright, Stephanie Cham, Tiffany Y. Sia, Timothy Wen
Country: United States
Language: English
Types: Population Health, Surgical Care, Utilization
Settings: Hospital, Specialist

Abstract

Objectives

Frailty, defined as loss of reserve and vulnerability to changes in health, affects many ovarian cancer patients who are planned to undergo surgery. The effect of frailty on postoperative readmissions in ovarian cancer patients remains poorly defined. We investigated the effect of frailty on unplanned readmission, morbidity, and mortality among patients undergoing surgery for ovarian cancer.

Study design

Patients who underwent laparotomy for ovarian cancer between 2010 and 2014 were identified using the Nationwide Readmissions Database. Frailty was classified using the Johns Hopkins Adjusted Clinical Groups Frailty Diagnoses Indicators. Primary outcomes were divided into index admission (intensive level of care, mortality, non-routine discharge,) 30-days (readmission and mortality), and 90-days (readmission and mortality). Multivariable regression models were fit, adjusting for patient, hospital, and clinical factors.

Results

From 2010 to 2014, there were 76,441 inpatient laparotomies identified with a 6.1% frailty rate. Frailty was associated with an increased risk of intensive level of care (aRR = 1.76, 95% CI: 1.68, 1.85), non-routine discharge (aRR = 1.39, 95% CI: 1.33, 1.45), and inpatient mortality (aRR = 1.91, 95% CI: 1.63, 2.23) during the index admission. Frail patients were more likely to be readmitted within 90 days (aRR = 1.11, 95% CI: 1.04–1.18), sustain mortality during 90-day readmission (aRR = 1.31, 95% CI 1.01–1.69), and have longer and costlier index hospital stays. Hospital readmission costs did not differ significantly between frail and non-frail patients.

Conclusions

Frailty affects postoperative outcomes in ovarian cancer patients and is associated with an increased rate of 90-day readmission and mortality among those who are readmitted. Gynecologic oncologists should screen for frailty and consider outcomes in frail ovarian cancer patients when counseling for surgery.

Ovarian cancer,Frailty,Hysterectomy,Debulking,Elderly,Cytoreduction

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