Tiffany C Lee1, Koffi Wima1, Jeffrey J Sussman1, Syed A Ahmad1, Jordan M Cloyd2, Ahmed Ahmed2, Keith Fournier3, Andrew J Lee3, Sean Dineen4, Benjamin Powers4, Jula Veerapong5, Joel M Baumgartner5, Callisia Clarke6, Harveshp Mogal6, Mohammad Y Zaidi7, Shishir K Maithel7, Jennifer Leiting8, Travis Grotz8, Laura Lambert9, Ryan J Hendrix9, Daniel E Abbott10, Courtney Pokrzywa10, Andrew M Blakely11, Byrne Lee11, Fabian M Johnston12, Jonathan Greer12, Sameer H Patel13,14. 1. Cincinnati Research on Outcomes and Safety in Surgery (CROSS), Division of Surgical Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA. 2. Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 3. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. 4. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL, USA. 5. Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA, USA. 6. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. 7. Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 8. Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA. 9. Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA. 10. Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA. 11. Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA. 12. Department of Surgery, Johns Hopkins University, Baltimore, MD, USA. 13. Cincinnati Research on Outcomes and Safety in Surgery (CROSS), Division of Surgical Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA. patel5se@ucmail.uc.edu. 14. Section of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way (ML 0558), Cincinnati, OH, 45267-0558, USA. patel5se@ucmail.uc.edu.
Abstract
BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) results in significant morbidity and readmissions. Previous studies have been limited by single-institution design or lack of tumor details in the database used. METHODS: The 12-institution US HIPEC Collaborative Database was queried between 1999 and 2017. Preoperative and intraoperative patient and tumor details were analyzed for associations with readmissions. RESULTS: A total of 2017 of 2372 cases were included in the analysis. The 30-day readmission rate was 15.9% (n = 321). Common indications for readmission included failure to thrive (29.9%), infection (23.6%), and ileus/bowel obstruction (15.1%). The readmitted cohort had more complications, including intra-abdominal abscess (21.2% vs 6.2%), ileus (28.0% vs 17.2%), anastomotic leak (11.2% vs 2.2%), enteric fistula (5.6% vs 1.5%), deep venous thrombosis (6.2% vs 2.5%), and pulmonary embolism (6.9% vs 2.5%). Factors independently associated with readmission (p < 0.05) included ECOG score ≥ 3 (OR 3.4), depression (OR 2.4), total parenteral nutrition (OR 3.6), low anterior resection or partial colectomy (OR 2.0), and stoma creation (OR 2.2). Factors not associated included neoadjuvant chemotherapy, peritoneal cancer index, and completeness of cytoreduction. Readmission rate between 31 and 90 days was 3.9% (n = 78). Independent predictors (p < 0.05) included operative time (OR 1.1), low anterior resection or partial colectomy (OR 1.7), and stoma creation (OR 2.2). CONCLUSIONS: In the largest study to date examining readmissions after CRS-HIPEC, 30-day readmission rate was 15.9%. Tumor factors failed to predict readmission, whereas preoperative functional status and depression along with individual cytoreductive procedures predicted readmission. Patients with these risk factors or postoperative complications may benefit from closer post-discharge monitoring.
BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) results in significant morbidity and readmissions. Previous studies have been limited by single-institution design or lack of tumor details in the database used. METHODS: The 12-institution US HIPEC Collaborative Database was queried between 1999 and 2017. Preoperative and intraoperative patient and tumor details were analyzed for associations with readmissions. RESULTS: A total of 2017 of 2372 cases were included in the analysis. The 30-day readmission rate was 15.9% (n = 321). Common indications for readmission included failure to thrive (29.9%), infection (23.6%), and ileus/bowel obstruction (15.1%). The readmitted cohort had more complications, including intra-abdominal abscess (21.2% vs 6.2%), ileus (28.0% vs 17.2%), anastomotic leak (11.2% vs 2.2%), enteric fistula (5.6% vs 1.5%), deep venous thrombosis (6.2% vs 2.5%), and pulmonary embolism (6.9% vs 2.5%). Factors independently associated with readmission (p < 0.05) included ECOG score ≥ 3 (OR 3.4), depression (OR 2.4), total parenteral nutrition (OR 3.6), low anterior resection or partial colectomy (OR 2.0), and stoma creation (OR 2.2). Factors not associated included neoadjuvant chemotherapy, peritoneal cancer index, and completeness of cytoreduction. Readmission rate between 31 and 90 days was 3.9% (n = 78). Independent predictors (p < 0.05) included operative time (OR 1.1), low anterior resection or partial colectomy (OR 1.7), and stoma creation (OR 2.2). CONCLUSIONS: In the largest study to date examining readmissions after CRS-HIPEC, 30-day readmission rate was 15.9%. Tumor factors failed to predict readmission, whereas preoperative functional status and depression along with individual cytoreductive procedures predicted readmission. Patients with these risk factors or postoperative complications may benefit from closer post-discharge monitoring.
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