Cognitive deficit identified via pre-operative patient reported outcome measures is a predictor for post-operative health care utilization in gynecologic oncology patients.

Abstract

Objective: To determine if preoperative Patient-Reported Outcome Measures (PROMs) can be used to predict post-operative health care utilization in gynecology oncology patients.

Methods: A retrospective study was performed after Institutional Review Board approval. PROMs were collected pre-operatively from all patients undergoing surgery for gynecologic malignancy between 1/1/18 and 9/1/19 at a tertiary academic medical center. Patients received the EORTC QLQ-C30 and Patient-Reported Outcomes Measure Information System emotional and instrumental support questionnaires along with a disease specific PROM. Charts were reviewed to ascertain healthcare utilization ("touches") in the 90-day postoperative period defined as phone calls, emails or portal messages, office visits, emergency department (ED) encounters, and hospital admissions. Linear regression was used to identify PROMs associated with postoperative healthcare utilization.

Results: Three hundred seventy-one patients were administered questionnaires of which 307 (82.7%) completed PROMs and were included for analysis. A significant association was noted between adverse responses on many EORTC QLQ-C30 domains and increased postoperative healthcare utilization. Of all questions, "difficulty remembering things" was most strongly associated with both overall utilization (total touches p=0.01) and utilization in multiple domains. After forward selection against other significant PROMs, as difficulty with memory increased, both overall healthcare utilization (adjusted regression coefficient 1.9, p=0.01) and ED encounters increased (adjusted regression coefficient 0.10, p=0.01).

Conclusion: Patients who report cognitive concerns are significantly more likely to have higher healthcare utilization postoperatively. Attention to this preoperatively could help identify patients at higher risk and further studies should determine if additional support around surgery can mitigate this risk.