M. Kanneganti1, P. Friedmann1, R. Levine1, H. In1 1Albert Einstein College Of Medicine,Surgical Oncology,Bronx, NY, USA
Introduction:
The circumstance of a person’s presentation at time of colorectal cancer (CRC) surgery is likely to influence outcomes. We aim to examine whether an admission through the emergency department and the presence of complicating factors (gastrointestinal bleeding (GIB), obstruction, and perforation) influence outcomes of CRC surgery.
Methods:
Nationwide Inpatient Sample (NIS) database was used. Patients who underwent surgery for CRC between 2007 and 2011 were included. CRC surgery patients were examined according to their admission circumstance; ER admission with complicating factors (ER-Cx), ER admission without complicating factors (ER-nonCx), non-ER admission with complicating factors (nonER-Cx) and non-ER admission without complicating factors(nonER-nonCx). Logistic regression models were used to estimate odds ratios of in-hospital death for admission status after adjusting for patient and hospital characteristics. Analyses were performed using SAS 9.4 (Cary, NC).
Results:
Of 81,774 patients, 5.2% were ER-Cx, 14.6% were ER-nonCx, and 3.8% were nonER-Cx. Patients with any ER admission or any complicating factors were more likely to be older (>75: 43.1% vs. 23.5%), black (12.7% vs. 5.9%) or Hispanic (7.2% vs. 4.1%), and have more comorbidities (3 or more: 22.9% vs.8.2%) compared to nonER-nonCx. These patients were also more likely to have complications (16.5% vs. 9.1%) and ostomies (26.6% vs. 15.0%). They had higher length of stay (LOS) as compared to all other patients [13.3 days (ER-nonCx), 12.9 days (nonER-Cx), 14.3 days(ER-Cx) vs. 7.9 days (nonER-nonCx)) and were less likely to be to be discharged home (65.0% vs. 85.8%). Adjusted logistic model shows that compared to nonER-nonCx, ER-nonCx (aOR 1.50, CI 1.29-1.75), nonER-Cx (aOR 2.06, CI 1.71-2.49) and ER-Cx (aOR 2.07, CI 1.73-2.47) were more likely to have in-hospital death.
Conclusion:
The circumstances for admission for CRC surgery independently influence outcomes. In our analysis, surgery after an ER presentation or surgery in the setting of GIB, obstruction or perforation is associated with worst outcomes. Future investigation should explore modifiable factors of ER admissions and admission with complicating factors, such as the timeliness of surgery. A patient’s presenting circumstance should be considered when evaluating outcomes and developing treatment plans following CRC surgery.