D. Burguete1, A. A. Mokdad2, M. M. Augustine2, R. Minter2, J. C. Mansour2, M. A. Choti2, P. M. Polanco2 1University Of Texas Southwestern Medical Center,Dallas, TX, USA 2University Of Texas Southwestern Medical Center,Division Of Surgical Oncology,Dallas, TX, USA
Introduction: The ability to preoperatively anticipate prolonged length of stay (PLOS) or transition to an extended care facility (non-home discharge, i.e., NHD) may facilitate discussion of patient expectations and improve utilization of hospital resources. Predictive models for NHD after some major surgical procedures have already been proposed. No data has been reported on the rate and risk factors associated with NHD and PLOS in patients following cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for peritoneal carcinomatosis. The aim of this study is to identify risk factors for NHD and PLOS following CRS/HIPEC in a national cohort of patients.
Methods: The National Surgical Quality Improvement Program (NSQIP) dataset was queried for patients who underwent CRS/HIPEC between 2011-2012. Patients designated as NHD and PLOS (>30d) were compared to the group of patients discharged to home within 30 days. Univariate analysis was used to compare patient demographics, preoperative labs, comorbidities, and intra and peri-operative variables among both groups. Multivariate analysis was used to identify independent predictors of NHD and PLOS.
Results: A total of 556 patients who underwent CRS/HIPEC were identified, of which 44 (7.91%) had a NHD/PLOS. From this group, 12 (27.2%) were discharged to a skilled care facility, 11 (25%) were discharged to a rehabilitation facility, and 21 (47.7%) remained hospitalized at 30 days. On univariate analysis, advancing age, chronic obstructive pulmonary disease, hypertension, low preoperative albumin and low preoperative platelets were identified as preoperative risk factors for NHD/PLOS (p values < 0.05). On multivariate analysis, age ≥ 65, pre-op albumin < 3.0 g/dL, and having a multi-visceral resection were identified as independent predictors of NHD/PLOS (Table 1.). If all three predictors are met, the probability of NHD/PLOS is 30.2%.
Conclusion: In this national cohort of patients, advanced age, hypoalbuminemia, and multi-visceral resection constituted the main risk factors for NHD/PLOS following CRS/HIPEC. Adequate identification of these risk factors may facilitate preoperative discussions with patients, and improve discharge planning and resource utilization.
