I. Solsky1,2, P. Friedmann1,2, P. Muscarella1,2, H. In1,2 1Montefiore Medical Center,Department Of Surgery,Bronx, NY, USA 2Albert Einstein College Of Medicine,Department Of Surgery,Bronx, NY, USA
Introduction: Outcomes following non-elective surgery for gastric cancer are poorly defined. Gastric cancers are mostly asymptomatic and the presence of symptoms generally signals more advanced disease. Studies suggest that emergent cancer surgery for gastrointestinal (GI) cancers are associated with later cancer stages and worse outcomes. Our objective was to compare outcomes of patients who underwent non-elective gastric cancer surgery following an admission through the emergency department (ED) with patients receiving elective surgery or surgery after planned admission using a US representative database.
Methods: Nationwide Inpatient Sample (NIS) was used to examine adults admitted with gastric cancer who underwent gastric cancer surgery over five years (2007-2011). NIS is an all-payer database designed to yield national estimates of hospital inpatient stays. Demographics and outcomes were compared between those who had their surgery performed non-electively after an ED admission with those who did not. Multivariable logistic regression was used to examine predictors of being discharged to home.
Results: 9,279 patients who underwent gastric cancer surgery were included for analysis. 1,143 (12%) underwent non-elective surgery following an ED admission. These patients were more likely to be female (42% vs. 35%), non-white (61% vs. 43%), elderly ≥75 years (40% vs. 26%), admitted to an urban non-teaching hospital (46% vs. 25%), in the lowest quartile for median household income (31% vs. 25%), and have one or more comorbidities (87% vs. 70%). They were less likely to have private insurance (19% vs. 37%). They had a longer median length of stay (16 vs. 9 days), number of days to surgery (5 vs. 0), were more likely to die during their hospitalization (8% vs. 3%) and less likely to be discharged home (63% vs. 82%). On multivariable logistic regression analysis, we found that having non-elective surgery following an ED admission was independently associated with a lower likelihood of being discharged to home [OR: 0.49 (95% CI: 0.42 – 0.57)]. On sensitivity analysis, our findings remained unchanged regardless of whether specific complications were included in the model.
Conclusion: Nationally, 12% of all gastric cancer surgeries are done following an admission through the ED. This tends to occur more frequently in vulnerable populations. Our finding that patients undergoing non-elective surgery following an ED admission had worse outcomes than those of patients getting surgery electively has implications towards the design of future studies to help improve outcomes for these patients. Outcomes after gastric cancer surgery may be improved by a) developing programs to detect gastric cancer in patients prior to the development of symptoms prompting presentation to the ED, b) improving access to health care in vulnerable populations, and c) encouraging elective scheduling of surgery for stable gastric cancer patients.