PM2 - The Hidden Length of Stay following Cytoreductive Surgery/HIPEC: Risk Factors for Unplanned 90-Day Readmission

Introduction: Cytoreductive surgery (CRS) with or without heated intraperitoneal chemotherapy (HIPEC) is associated with significant morbidity. While decreasing post-operative length of stay (LOS) is a goal of enhanced recovery protocols, CRS/HIPEC patients frequently experience unplanned readmissions. The purpose of this study was to evaluate the frequency and risk factors for unplanned 90-day readmissions and their impact on overall hospital LOS.

Methods: Patients undergoing CRS/HIPEC from January 2017-August 2019 were included. Initial post-operative LOS and total hospital LOS, including additional inpatient days due to unplanned 90-day readmissions, were compared to quantify the impact of readmissions on LOS. Risk factors for unplanned 90-day readmission were evaluated.

Results: 143 patients underwent CRS with 74.8% of patients receiving HIPEC. The median initial LOS was 9 days (IQR 7-13) and 23.8% of patients experienced an unplanned readmission. The most common etiologies for readmission included infections (45.5%), poor oral intake/dehydration (25.6%) and symptoms of bowel obstruction (13.9%). Although readmissions increased the median total hospital LOS to only 10 days (IQR 7-16), readmissions accounted for an 18.1% increase in total inpatient hospital days for the entire cohort. Factors associated with readmission included higher PCI score (p=0.004), increased number of bowel anastomoses (p=0.005), higher intraoperative blood loss (p<0.001), and more severe post-operative complications (p=0.024). Multivisceral resection was not associated with increased readmissions.

Discussion: Unplanned 90-day readmission is prevalent among patients who undergo CRS/HIPEC and significantly contributes to the overall hospital days. Impaired gastrointestinal function in patients undergoing more extensive gastrointestinal tract reconstruction contributes significantly to readmissions.