Abstract A006: Performance of the laparoscopic hysterectomy readmission score among diverse women with endometrial cancer

Abstract

Abstract Introduction: Readmission following cancer-directed surgery is an important quality metric. The laparoscopic hysterectomy readmission score (LHRS) was developed to identify women for whom same day discharge after minimally invasive surgery was suitable, with low readmission risk. Our single-institution cohort study supported the hypothesis that the LHRS was associated with increased readmission odds in a gynecologic oncology population; however, this analysis was limited by the racial homogeneity of the cohort. In addition, an assessment of discrimination of the LHRS has not been performed. Therefore, we evaluated readmission odds and performance associated with the LHRS among women with endometrial cancer (EC) overall and by race/ethnicity. Methods: Using data from the National Surgical Quality Improvement Program (NSQIP), we calculated the LHRS by assigning one point to the following six variables (diabetes, severe chronic obstructive pulmonary disease, disseminated cancer, chronic steroid use, bleeding disorder, length of surgery of two hours or longer) and two points for any postoperative complication occurring prior to discharge (range: 0-8). We dichotomized LHRS (<3, ≥3) and examined odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day readmission odds using logistic regression in the overall study population and stratified by race/ethnicity (White, Black, Hispanic, Asian, Native Hawaiian/Pacific Islander, American Indian or Alaska Native). Discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUC) in the overall study population and by race/ethnicity. Results: In this study of 27,981 EC patients diagnosed between 2014 and 2020, overall readmission was low (3.1%). The majority of women were White (80%), followed by Black (7.6%), Hispanic (6.0%), Asian (4.9%), Native Hawaiian/Pacific Islander (1.1%), and American Indian/Alaska Native (0.4%). Overall, readmission odds were higher among those with LHRS ≥3 vs. <3 (OR=3.10, 95% CI=2.31, 4.15) with similar associations in race/ethnicity-stratified models. In the overall study population, the AUC was not much better than chance (0.52, 95% CI=0.51, 0.53). AUCs of the LHRS stratified by race/ethnicity were: 0.52, (95% CI=0.51, 0.53), 0.53 (95% CI=0.51, 0.56), 0.53 (95% CI=0.50, 0.58), 0.49 (95% CI=0.491, 0.50), 0.49 (95% CI=0.47, 0.49), and 0.65 (95% CI=0.47, 0.99) among White, Black, Hispanic, Asian, Native Hawaiian/Pacific Islander, and American Indian/Alaskan Native women, respectively. Discussion: We observed higher readmission odds associated with higher LHRS in the overall cohort of EC patients and among race/ethnicity subgroups. Performance metrics for the LHRS generally demonstrated low predictive ability. Citation Format: Jennifer A. Sinnott, Caitlin E. Meade, Michelle D.S. Lightfoot, David A. Barrington, Casey M. Cosgrove, Laura M. Chambers, Ashley S. Felix. Performance of the laparoscopic hysterectomy readmission score among diverse women with endometrial cancer [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr A006.