K. T. Collier1, J. Tong1, G. Karakousis1, S. Dasani1, R. R. Kelz1 1University Of Pennsvlvania,Department Of Surgery,Philadelphia, PA, USA
Background: Despite efforts to select medically appropriate patients for surgery, some patients remain high risk. We sought to examine admissions following surgical resection of 4 intra-abdominal malignancies to better prepare patients for the surgical experience and to identify potential patients at risk for multiple admissions.
Methods: Patients with an established diagnosis of colon, rectal, stomach or pancreas cancer who were admitted to the hospital for the first time since diagnosis and underwent surgical resection In New York or California (2008-2011) were identified for study inclusion. Patients were excluded if they had a post-operative complication during the index admission. Rates of multiple admissions (MuAdm) at or exceeding the 90th percentile of admissions within each cancer type were tabulated. MuAdm was defined as >=2 admissions for colon and rectal cancer and >=3 admissions for pancreas and stomach cancer patients. Univariate analysis was performed to determine patient characteristics known at the time of admission that were associated with MuAdm. Independent multivariate logistic regression models were developed to identify patient cohorts at risk for MuAdm within each malignancy type. The Bonferroni correction was used to adjust for multiple comparisons.
Results: Of 32,601 patients, 22,761 underwent surgery for colon cancer, 5,875 rectal cancer, 1,594 pancreas cancer and 2,371 stomach cancer. The median age of patients for was 68 (IQR: 57-77), median number of comorbidities was 3 (IQR:3-5), 51.5% of patients were female, and 19% of study population was admitted through the emergency department. The overall 1-yr rate of any post-operative admission was 37.91%; with 33.9% for colon cancer, 47.4% rectal cancer, 49.6% pancreas cancer and 45.34% stomach cancer (p<0.001). The rate of MuAdm was 14% for colon cancer, 19.3% rectal cancer, 12.74% pancreas cancer and 11.05% stomach cancer (p<0.001). The number of MuAdm ranged from (2-26) for colon cancer patients, (2-16) for rectal cancer patients, (3-11) for pancreas cancer patients and (3-12) for stomach cancer patients. Factors associated with MuAdm on multivariate analysis, after Bonferroni adjustment for multiple comparisons, are shown in Table 1.
Conclusions: At least 40% of patients undergoing surgical resection of an intra-abdominal malignancy without complications will be admitted to the hospital at least one time in the subsequent year. For some patients, there will be multiple admissions. Risk factors for multiple admissions differ by tumor type. In patients with multiple risks, alternatives to the standard of care should be considered.
