N.N. Chakraborty1,2, O.S. Pawar3, T. Lal1,2, R.S. Hoehn1,2, L.D. Rothermel1,2 1Case Western Reserve University, School Of Medicine, Cleveland, OH, USA 2University Hospitals Cleveland Medical Center, Division Of Surgical Oncology, Cleveland, OH, USA 3University Hospitals Cleveland Medical Center, Department Of Surgery, Cleveland, OH, USA
Introduction: Sentinel lymph node biopsy (SLNB) provides persistent prognostic value for elderly patients with melanoma. However, SLNB is performed less often in elderly patients, due in part to a higher perceived risk of perioperative morbidity. We sought to determine whether rates of unplanned hospital readmission were higher in elderly patients with melanoma after SLNB.
Methods: We conducted a retrospective analysis of the National Cancer Database (NCDB: 2012-2021), identifying adult patients who underwent SLNB for cutaneous melanoma. Patients were stratified based on sociodemographic, tumor, and hospital characteristics, and we calculated relative frequencies of unplanned readmission within 30 days post-surgery. Chi-square tests were used to evaluate the association of each clinical factor with readmission status. Multivariable logistic regression was employed to assess the independent effect of each variable on unplanned readmission.
Results: Among 161,973 patients who underwent SLNB for cutaneous melanoma, 1,691 patients (1.0%) had unplanned readmissions to the hospital within 30 days. Univariate analysis revealed that all variables we analyzed, except for race, were significantly associated with readmission. Multivariate analysis indicated that patients aged ≥ 70 had a 33% greater likelihood of unplanned 30-day readmission compared to younger patients (95% CI: 1.20-1.47). Additionally, patients with Charlson Comorbidity Index ≥ 3 (OR 1.34, 95% CI: 1.01-1.77), Hispanic or Spanish ethnicity (OR 2.13, 95% CI: 1.63-2.79), treatment at a comprehensive community cancer program (OR 2.31, 95% CI: 1.70-3.14), and melanoma of the lower limb/hip (OR 1.80, 95% CI: 1.55-2.09) had increased odds of unplanned readmission. Conversely, female patients were 19% less likely to be readmitted compared to males (95% CI: 0.73-0.90) (Table 1).
Conclusion: Unplanned readmission after SLNB for melanoma is uncommon at all ages. While patients ≥ 70 years old have a 33% higher likelihood of unplanned readmission within 30 days of SLNB compared to younger patients, the readmission rate in this age group remains low (1.3%). Further investigation is needed to elucidate whether older patients have increased risk of perioperative morbidity after SLNB compared to younger patients.