Background

With the increasing rates of same-day discharge following minimally invasive surgery for endometrial cancer, the need for and value of routine postoperative testing is unclear.

Objective

This study aimed to determine whether routine postoperative laboratory testing following minimally invasive hysterectomy for endometrial cancer leads to clinically significant changes in postoperative care.

Study Design

This was a single-institution retrospective cohort study of patients undergoing minimally invasive hysterectomy for endometrial cancer by a gynecologic oncologist between June 2014 and June 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 testing was computed using hospital-level cost data.

Results

Of the 649 women included in the analysis, most (91.4%) were White, with a mean age of 61 years, and mean body mass index of 38.0 kg/m². The most common comorbidities were diabetes mellitus (31.9%, n=207), chronic pulmonary disease (7.9%, n=51), and congestive heart failure (3.2%, n=21). Median operative time was 151 minutes (range, 61–278), and median estimated blood loss was 100 mL (range, 10–1500). Most patients (68.6%, n=445) underwent lymphadenectomy. All patients had postoperative laboratory tests ordered: 100% complete blood count, 99.7% chemistry, 62.9% magnesium, 46.8% phosphate, 37.4% calcium, and 1.2% liver function tests. Twenty-six patients (4.0%) had a change in management owing to postoperative laboratory test results. Of these 26 women, 88% experienced a change in clinical status that would have otherwise prompted testing. Only 3 (0.5% of entire cohort) were asymptomatic: 1 received a blood transfusion for asymptomatic anemia, and the other 2, who did not carry a diagnosis of diabetes mellitus, had interventions for hyperglycemia. On univariable analysis, peripheral and cerebrovascular disease, diabetes mellitus with end-organ damage, and a Charlson Comorbidity Index of ≥3 were associated with increased odds of change in management; these were not significant on multivariable analysis. Routine postoperative laboratory evaluation in this cohort increased hospital costs by $292,000.

Conclusion

Routine postoperative laboratory tests are unlikely to lead to significant changes in management for women undergoing minimally invasive hysterectomy for endometrial cancer, and may increase cost without providing a discernible clinical benefit. In the setting of strict postoperative guidelines, laboratory tests should be ordered when clinically indicated rather than as part of routine postoperative management for women undergoing minimally invasive hysterectomy for endometrial cancer.

中文翻译：

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少即是多：子宫内膜癌微创子宫切除术后实验室检查的临床应用

背景

随着子宫内膜癌微创手术后当天出院率的增加，常规术后检测的必要性和价值尚不清楚。

客观的

本研究旨在确定子宫内膜癌微创子宫切除术后的常规术后实验室检查是否会导致术后护理的临床显着变化。

学习规划

这是一项由妇科肿瘤学家于 2014 年 6 月至 2017 年 6 月期间接受子宫内膜癌微创子宫切除术的患者的单机构回顾性队列研究。病历。实验室检测的经济负担是使用医院层面的成本数据计算的。

结果

在分析中包括的 649 名女性中，大多数 (91.4%) 是白人，平均年龄为 61 岁，平均体重指数为 38.0 kg/m ². 最常见的合并症是糖尿病（31.9%，n=207）、慢性肺病（7.9%，n=51）和充血性心力衰竭（3.2%，n=21）。中位手术时间为 151 分钟（范围，61-278），中位估计失血量为 100 mL（范围，10-1500）。大多数患者 (68.6%, n=445) 接受了淋巴结清扫术。所有患者均接受了术后实验室检查：100% 全血细胞计数、99.7% 化学、62.9% 镁、46.8% 磷酸盐、37.4% 钙和 1.2% 肝功能检查。由于术后实验室检查结果，26 名患者 (4.0%) 的管理发生了变化。在这 26 名女性中，88% 的人经历了临床状态的变化，否则会促使进行检测。只有 3 人（占整个队列的 0.5%）没有症状：1 人因无症状贫血接受输血，另外 2 人，未被诊断患有糖尿病的人接受了高血糖干预措施。在单变量分析中，外周和脑血管疾病、伴有终末器官损害的糖尿病和≥3 的 Charlson 合并症指数与增加的管理变化几率相关；这些在多变量分析中并不显着。该队列中的常规术后实验室评估使住院费用增加了 292,000 美元。

结论

常规术后实验室检查不太可能导致因子宫内膜癌接受微创子宫切除术的妇女的管理发生重大变化，并且可能会增加成本而不会提供明显的临床益处。在严格的术后指南中，对于因子宫内膜癌接受微创子宫切除术的女性，在有临床指征时应进行实验室检查，而不是将其作为常规术后管理的一部分。