Y. A. Zerhouni1,3, N. Melnitchouk1, E. B. Schneider2 1Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 2Ohio State University,Columbus, OH, USA 3UCSF- East Bay,Surgery,Oakland, CA, USA
Introduction:
Emergent presentations of colorectal cancer (CRC) are associated with worse outcomes. We examined patient factors associated with in-hospital death and discharge to continuing care.
Methods:
We queried the 2008–2013 Nationwide Emergency Department Sample, a 20% stratified sample of United States (US) ED visits, and identified all visits with a primary ICD-9-CM diagnosis of CRC. Multivariable logistic regression was used to identify factors associated with in-hospital death or discharge to continuing care (skilled nursing facility, long-term hospital, or home health care).
Results:
Approximately 312,105 ED visits were made for a primary diagnosis of CRC. 70.9% of patients were aged ≥60 years and 58.3%% were covered by Medicare. Over one-third had proximal disease (proximal 36.3%, distal 16.6%, rectum 22.7%, unspecified 24.4%). Nearly 1 in 3 patients had metastatic CRC. 89.0% of patients were admitted to the hospital. 50.5% of patients underwent a surgical procedure (colon resection, ostomy, stent, dilation). At discharge, 49.0% required continuing care. 5.6% died during the hospitalization. The average total charges for the encounter were $83,904 and average length of stay was 10.1 days. Factors associated with discharge to continuing care can be seen in Figure 1. Factors significantly associated with in-hospital death included moderate to severe liver disease (OR 4.82), metastatic CRC (OR 2.12), malnutrition (OR 1.81), mild liver disease (OR 1.78), history of myocardial infarction (OR 1.65), congestive heart failure (OR 1.59), cerebrovascular disease (OR 1.59), and chronic renal disease (1.43).
Conclusion:
ED visits for a primary diagnosis of CRC consume substantial resources with nearly 90% of patients admitted to the hospital and over half (50.5%) requiring surgical intervention. Nearly half of the patients who survive to discharge (49.0%) require some form of additional care. Factors that increase likelihood of in-hospital death or discharge to continuing care should inform patient care.
