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.