Predischarge Prediction of Readmission After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Derivation and Validation of a Risk Prediction Score
| Autor: | Caroline J. Rieser, Amer H. Zureikat, James F. Pingpank, Matthew P. Holtzman, David L Bartlett, M. Haroon A. Choudry, Lauren B Hall, Eliza Kang |
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| Rok vydání: | 2020 |
| Předmět: |
Peritoneal Surface Malignancy
medicine.medical_specialty Logistic regression Patient Readmission 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine Humans 030212 general & internal medicine Derivation Retrospective Studies Framingham Risk Score business.industry Area under the curve Retrospective cohort study Perioperative Cytoreduction Surgical Procedures Hyperthermia Induced Oncology 030220 oncology & carcinogenesis Peritoneal Cancer Index Surgery Hyperthermic intraperitoneal chemotherapy business |
| Zdroj: | Annals of Surgical Oncology |
| ISSN: | 1534-4681 |
| Popis: | Background Ninety-day hospital readmission rates following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) range from 20 to 40%. Objective The aim of this study was to develop and validate a simple score to predict readmissions following CRS/HIPEC. Study Design Using a prospectively maintained database, we retrospectively reviewed clinicopathologic, perioperative, and day-of-discharge data for patients undergoing CRS/HIPEC for peritoneal surface malignancies between 2010 and 2018. In-hospital mortalities and discharges to hospice were excluded. Multivariate logistic regression was utilized to identify predictors of unplanned readmission, with three-quarters of the sample randomly selected as the derivation cohort and one-quarter as the validation cohort. Using regression coefficient-based scoring methods, we developed a weighted 7-factor, 10-point predictive score for risk of readmission. Results Overall, 1068 eligible discharges were analyzed; 379 patients were readmitted within 90 days (35.5%). Seven factors were associated with readmission: stoma creation, Peritoneal Cancer Index score ≥ 15, hyponatremia, in-hospital major complication, preoperative chemotherapy, anemia, and discharge to nursing home. In the validation cohort, 25 patients (9.2%) were categorized as high risk for readmission, with a predicted rate of readmission of 69.3% and an observed rate of 76.0%. The score had fair discrimination (area under the curve 0.70) and good calibration (Hosmer–Lemeshow goodness-of-fit p-value of 0.77). Conclusion Our proposed risk score, easily obtainable on day of discharge, distinguishes patients at high risk for readmission over 90 days following CRS/HIPEC. This score has the potential to target high-risk individuals for intensive follow-up and other interventions. |
| Databáze: | OpenAIRE |
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