The following is a summary of “Less is more: clinical utility of postoperative laboratory testing following minimally invasive hysterectomy for endometrial cancer,” published in the January 2023 issue of Obstetrics and Gynecology by Lightfoot, et al.

The necessity and benefit of regular postoperative tests were uncertain given the rising rates of same-day discharge following minimally invasive surgery for endometrial cancer. For a study, researchers sought to determine whether standard postoperative laboratory testing after minimally invasive hysterectomy for endometrial cancer affected postoperative treatment in a way that is clinically significant.

Those who underwent a minimally invasive hysterectomy for endometrial cancer by a gynecologic oncologist between June 2014 and June 2017 were the subjects of this retrospective cohort analysis at a single institution. The following information was manually retrieved from the patient’s medical records: demographics, preoperative comorbidities, surgical and postoperative data, and pathologic results. Using cost information from hospitals, the financial burden of laboratory testing was calculated.

The majority (91.4%) of the 649 women that were analyzed were White, with a mean age of 61 years and a mean body mass index of 38.0 kg/m². Diabetes mellitus (31.9%, n=207), chronic lung illness (7.9%, n=51), and congestive heart failure (3.2%, n=21) were the most prevalent comorbidities. 151 minutes was the median operating duration (the range was 61-278), and 100 mL (range, 10–1,500) was the median estimated blood loss. (68.6%, n=445) The majority of patients received lymphadenectomy. Postoperative laboratory testing was mandated for all patients and included the following tests: 100% complete blood count, 99.7% chemistry, 62.9% magnesium, 46.8% phosphate, 37.4% calcium, and 1.2% liver function tests. Results of postoperative laboratory tests led to a change in care for 26 patients (4.0%). The clinical status of these 26 women changed in 88% of cases, which would have normally required testing. Only 3 people (0.5% of the entire cohort) exhibited no symptoms; of these, 2 had treatments for hyperglycemia, while the other needed a blood transfusion for asymptomatic anemia. Peripheral and cerebral vascular disease, diabetes mellitus with end-organ damage, and a Charlson Comorbidity Index of ≥3 were all linked to an increased likelihood of management change on a univariable analysis; however, these associations were not significant on a multivariable analysis. Costs at the hospital rose by $292,000 in this group due to routine postoperative laboratory testing.

Routine postoperative laboratory testing raised expenses without adding any clear therapeutic value, and they were unlikely to result in meaningful care changes for women receiving minimally invasive hysterectomies for endometrial cancer. For women with a minimally invasive hysterectomy for endometrial cancer, laboratory testing should only be conducted when clinically necessary rather than as part of normal postoperative therapy.

Reference: ajog.org/article/S0002-9378(22)00629-9/fulltext