Preoperatively predicting non-home discharge after surgery for gynecologic malignancy |
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| Authors: | Courtney A. Penn Neil S. Kamdar Daniel M. Morgan Ryan J. Spencer Shitanshu Uppal |
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| Affiliation: | 1. Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA;2. Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd., Ann Arbor, MI 48109, USA;3. Department of Emergency Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA;4. Department of Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA;5. Division of Urogynecology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA;6. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin, 750 Highland Ave., Madison, WI 53705, USA;7. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA |
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| Abstract: | ObjectiveReturning home after surgery is a desirable patient-centered outcome associated with decreased costs compared to non-home discharge. Our objective was to develop a preoperative risk-scoring model predicting non-home discharge after surgery for gynecologic malignancy.MethodsWomen who underwent surgery involving hysterectomy for gynecologic malignancy from 2013 to 2015 were identified from the Michigan Surgical Quality Collaborative database. Patients were divided by discharge destination, and a multivariable logistic regression model was developed to create a nomogram to assign case-specific risk scores. The model was validated using the National Surgical Quality Improvement Program (NSQIP) database.ResultsNon-home discharge occurred in 3.1% of 2134 women. The proportion of non-home discharges did not differ by cancer diagnosis (uterine 3.5%, ovarian 2.5%, and cervical 1.6%, p?=?0.2). Skilled nursing facilities were the most common non-home destination (68.2%). Among patients with comorbidities (hypertension, diabetes, coronary artery disease, chronic obstructive pulmonary disease /dyspnea, arrhythmia, and history of deep vein thrombosis/pulmonary embolism), non-home discharge was more common in women with 1 (adjusted OR [aOR] 3.4; p?=?0.03) or ≥2 of these comorbidities (aOR 5.1; p?=?0.003) compared to none. Non-home discharge was more common after laparotomy (aOR 6.7; p?p?=?0.0004) and dependent functional status (aOR 8.7; p? ConclusionsNon-home discharge after surgery for gynecologic malignancy was predicted with high accuracy in this retrospective analysis. |
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| Keywords: | Discharge destination Hysterectomy Gynecologic malignancy Risk model Prediction |
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