Uterine cancer, the most prevalent form of which is endometrial cancer (EC), is the most commonly diagnosed female reproductive tract malignancy in the United States (U.S.), with 69,120 new diagnoses expected in 2025 [1]. Minimally invasive surgical techniques are standard of care for EC management, offering benefits such as lower complication rates, quicker return to normal activities, and shorter hospital stays compared with laparotomy [[2], [3], [4]]. With increasing adoption of minimally invasive hysterectomy among patients with EC [5], concomitant rises in same-day discharge (SDD) have been observed [2,6]. SDD is regarded as safe, particularly in the population of those undergoing laparoscopy for benign conditions [[7], [8], [9], [10], [11], [12]]. Accumulating evidence in gynecologic oncology populations has similarly shown that SDD is safe and increasingly adopted for patients with EC [[13], [14], [15], [16], [17]]. Several contemporary studies from high-volume cancer centers have reported SDD rates exceeding 70–80 % among EC patients undergoing minimally invasive hysterectomy [18,19]. Despite this progress, SDD has not been adopted across all surgical centers, and risk-stratified tools to guide clinical decisions around SDD, particularly tools that identify patients at increased risk of readmission, remain underutilized. A primary concern with SDD following minimally invasive hysterectomy is the risk of unplanned hospital readmission. This concern stems from the assumption that potential postoperative complications may be more effectively identified during an inpatient stay, whereas patients discharged on the day of surgery might have issues that go undetected, potentially leading to higher readmission rates. Thus, efforts to develop preoperative risk calculators to select patients at low risk of readmission following minimally invasive surgery, while limited, may be informative to guide SDD decisions.

The laparoscopic hysterectomy readmission score (LHRS), which quantifies readmission risk in the setting of laparoscopic gynecologic surgery, incorporates factors available prior to patient discharge (e.g., diabetes, surgical duration ≥two hours, postoperative complication prior to discharge). Developed and internally tested within the National Surgical Quality Inpatient (NSQIP) database, the LHRS ranges from 0 (low readmission risk) to 8 (high readmission risk), with an LHRS ≥3 associated with higher readmission (9.6 %) compared to an LHRS <3 (2.8 %) [6]. Importantly, the extent to which the LHRS is predictive of 30-day readmission in the setting of malignant indications has not been well-addressed. In our single-institution study of 423 gynecologic oncology patients undergoing minimally invasive hysterectomy, we demonstrated that an LHRS ≥3 vs. <3 was associated with four-fold higher odds of readmission, supporting the original threshold proposed in the development of the LHRS while also suggesting the utility of the LHRS in the gynecologic cancer population [20]. Whether the LHRS is predictive of readmission among patients with EC has not been evaluated; however, if the LHRS is highly predictive in this population, an automated assessment tool could be implemented to better inform clinical decision-making around expectations following surgery.

Several important gaps remain. First, performance characteristics (i.e., model calibration and discrimination) of the LHRS have not been examined in the EC patient population. Second, we lack information on the extent to which the LHRS is associated with readmission according to race and ethnicity. Given prior data suggesting racially disparate readmission risks among patients with EC [5], we sought to evaluate LHRS performance characteristics and readmission odds in the overall study population and by race and ethnicity. Our goal was to assess the utility of this risk calculator in a specific cancer population (e.g., EC) characterized by racial and ethnic disparities in multiple metrics and with increasing incidence among women of all racial and ethnic groups [21].