Less is more: clinical utility of postoperative labs following minimally invasive hysterectomy for endometrial cancer

Abstract

<h3>Objectives:</h3> With the Increasing rates of same day discharge following minimally invasive endometrial cancer (EC) surgery, the need for and value of routine postoperative testing is unclear. We determined whether routine postoperative labs following minimally invasive hysterectomy for EC led to clinically significant changes in postoperative care. <h3>Methods:</h3> This was a single-institution retrospective cohort study of patients undergoing minimally invasive hysterectomy for EC by a gynecologic oncologist. A random sample was selected from an existing database of patients who underwent surgery for EC between June 2014-2017. Patient demographics, preoperative comorbidities, operative and postoperative data, and pathologic findings were manually extracted from the patients' medical records. The financial burden of laboratory evaluation was computed using hospital-level cost data. <h3>Results:</h3> Of the 266 women included in the analysis, the majority (91.4%) were White, with a mean age of 61.5 years, and mean BMI of 38.0±10.1kg/m². The most common comorbidities were diabetes (29.3%, n=78), chronic pulmonary disease (7.9%, n=21), and renal disease (3.8%, n=10). The mean operative time was 152.1±37.8 minutes and mean EBL was 105±91.7mL. Most patients (66.5%, n=177) underwent LAD, of which 77.4% had sentinel (n=78) and/or complete pelvic LAD (n=128), and an additional 42.4% (n=75) underwent paraaortic lymph node assessment. All patients had post-operative labs ordered: 100% complete blood count, 99.2% chemistry, 55.3% magnesium, 44.7% phosphate, 39.8% calcium, 3.4% PT/PTT/INR, 1.9% liver function tests, and 15% other. The mean pre- and post-operative hemoglobin was 13.5±1.4g/dL and 11.5±1.3g/dL, respectively. Mean pre- and post-operative creatinine were 0.83±0.21mg/dL and 0.78±0.20mg/dL. Thirteen patients (4.9%) had a change in management due to postoperative lab results (Table 1). Of these, only two patients (0.8% of entire cohort) had no symptoms or change in clinical status that would have otherwise prompted labs to be performed: one received a blood transfusion for asymptomatic anemia and the other electrolyte repletion for asymptomatic hypomagnesemia of 1.2mg/dL. There were no preoperative or operative factors significantly associated with a postoperative change in management due to labs, postoperative creatinine or postoperative hemoglobin. Routine postoperative laboratory evaluation in this cohort increased hospital costs by $118,455 or approximately $445 per patient. <h3>Conclusions:</h3> Routine postoperative labs are unlikely to lead to significant changes in management for women undergoing minimally invasive hysterectomy for EC, and may increase cost without providing a discernable clinical benefit. In the setting of strict post-operative guidelines, laboratory tests should be ordered when clinically indicated rather than as part of routine postoperative management for women undergoing minimally invasive hysterectomy for EC.