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

ABSTRACT

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

To determine whether routine postoperative labs following minimally invasive hysterectomy for endometrial cancer leads to clinically significant changes in postoperative care.

Study Design

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

Results

Of the 649 women included in the analysis, the majority (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 (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 minutes) and median estimated blood loss was 100 mL (range 10-1500 mL). Most patients (68.6%, n=445) underwent lymphadenectomy. All patients had post-operative labs 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 due to postoperative lab results. Of these 26 women, 88% experienced a change in clinical status that would have otherwise prompted testing. Only three (0.5% of entire cohort) were asymptomatic: one received a blood transfusion for asymptomatic anemia and the other two, who did not carry a diagnosis of diabetes, had interventions for hyperglycemia. On univariable analysis, peripheral and cerebrovascular disease, diabetes 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.

Conclusions

Routine postoperative labs 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 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 endometrial cancer.