E. H. Wood1, A. N. Kothari1, P. C. Kuo1, J. Eberhardt1, T. Saclarides1, D. Hayden1 1Loyola University Medical Center,Surgery,Maywood, ILLINOIS, USA
Introduction:
Metastatic colon cancer and metastatic rectal cancer are pathophysiologically distinct and affect different patient populations. Our aim is to describe patient-level characteristics that may vary between the two diseases.
Methods:
Healthcare Cost and Utilization Project State Inpatient Database from 2006-2011 for Florida was queried using ICD-9 and ICD-9-CM codes to identify adult patients admitted with metastatic colon and metastatic rectal cancer. Descriptive statistics were obtained examining patient demographics as well as details of each hospital admission.
Results:
13,916 patients with metastatic rectal cancer were admitted a total of 27,235 times during our study period (average 1.96 admissions per patient). 45,611 patients with metastatic colon cancer were admitted 67,057 times (average 1.47 admissions per patient). Admissions were more likely to be elective in patients with metastatic rectal cancer (46.3% vs. 38.5%, p<0.001). Average length of stay for all hospitalizations was 7.7 and was similar between both rectal cancer and colon cancer groups, 7.5 and 7.8 days respectively. Rate of inpatient mortality was higher in patients with stage IV colon cancer (4.4% vs. 3.2%, p<0.001). Stage IV rectal cancer patients were younger (66.4 vs 70.8, p<0.001), and more likely to be male (56.8% vs. 50.4%, p<0.001). Rectal cancer patients were more likely to be white (75.5% vs 73.9%, p<0.001) while colon cancer patients were more likely to be black (11.1% vs. 9.0%, p<0.001). Colon cancer patients were more likely to be from the lowest income quartile (28.8% vs. 27.5%, p<0.001) and more likely to use Medicare as their primary payer while rectal cancer patients were more likely to have Medicaid or private insurance. 48.3% of patients with colon cancer underwent surgery while only 27.4% of patients with rectal cancer underwent surgery in the same period. LOS after surgery in patients with colon cancer was greater than for patients with rectal cancer (9.7 vs. 8.8 days, p<0.001). Mortality during the admission for surgery was higher in patients with colon cancer (2.65% vs. 1.48%, p<0.001).
Conclusion:
Patients with metastatic rectal cancer tend to be younger, white, male patients from wealthier socioeconomic areas who are more likely to have elective admissions for their diseases. They are less likely to undergo operative intervention during their hospitalization, and their admissions carry a lower risk of mortality. These results begin to show that metastatic colon and rectal cancers affect distinct patient populations that may have access to different care delivery resources that ultimately impact their overall survival.