TY - JOUR
T1 - Predictors of Nonhome Discharge after Cytoreductive Surgery and HIPEC
AU - Kubi, Boateng
AU - Gunn, Jonathan
AU - Fackche, Nadege
AU - Cloyd, Jordan M.
AU - Abdel-Misih, Sherif
AU - Grotz, Travis
AU - Leiting, Jennifer
AU - Fournier, Keith
AU - Lee, Andrew J.
AU - Dineen, Sean
AU - Dessureault, Sophie
AU - Veerapong, Jula
AU - Baumgartner, Joel M.
AU - Clarke, Callisia
AU - Mogal, Harveshp
AU - Patel, Sameer H.
AU - Dhar, Vikrom
AU - Lambert, Laura
AU - Hendrix, Ryan J.
AU - Abbott, Daniel E.
AU - Pokrzywa, Courtney
AU - Raoof, Mustafa
AU - Lee, Byrne
AU - Maithel, Shishir K.
AU - Staley, Charles A.
AU - Johnston, Fabian M.
AU - Wang, Nae Yuh
AU - Greer, Jonathan B.
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/11
Y1 - 2020/11
N2 - Background: Using a national database of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) recipients, we sought to determine risk factors for nonhome discharge (NHD) in a cohort of patients. Methods: Patients undergoing CRS/HIPEC at any one of 12 participating sites between 2000 and 2017 were identified. Univariate analysis was used to compare the characteristics, operative variables, and postoperative complications of patients discharged home and patients with NHD. Multivariate logistic regression was used to identify independent risk factors of NHD. Results: The cohort included 1593 patients, of which 70 (4.4%) had an NHD. The median [range] peritoneal cancer index in our cohort was 14 [0-39]. Significant predictors of NHD identified in our regression analysis were advanced age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.05-1.12; P < 0.001), an American Society of Anesthesiologists (ASA) score of 4 (OR, 2.87; 95% CI, 1.21-6.83; P = 0.017), appendiceal histology (OR, 3.14; 95% CI 1.57-6.28; P = 0.001), smoking history (OR, 3.22; 95% CI, 1.70-6.12; P < 0.001), postoperative total parenteral nutrition (OR, 3.14; 95% CI, 1.70-5.81; P < 0.001), respiratory complications (OR, 7.40; 95% CI, 3.36-16.31; P < 0.001), wound site infections (OR, 3.12; 95% CI, 1.58-6.17; P = 0.001), preoperative hemoglobin (OR, 0.81; 95% CI, 0.70-0.94; P = 0.006), and total number of complications (OR, 1.41; 95% CI, 1.16-1.73; P < 0.001). Conclusions: Early identification of patients at high risk for NHD after CRS/HIPEC is key for preoperative and postoperative counseling and resource allocation, as well as minimizing hospital-acquired conditions and associated health care costs.
AB - Background: Using a national database of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) recipients, we sought to determine risk factors for nonhome discharge (NHD) in a cohort of patients. Methods: Patients undergoing CRS/HIPEC at any one of 12 participating sites between 2000 and 2017 were identified. Univariate analysis was used to compare the characteristics, operative variables, and postoperative complications of patients discharged home and patients with NHD. Multivariate logistic regression was used to identify independent risk factors of NHD. Results: The cohort included 1593 patients, of which 70 (4.4%) had an NHD. The median [range] peritoneal cancer index in our cohort was 14 [0-39]. Significant predictors of NHD identified in our regression analysis were advanced age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.05-1.12; P < 0.001), an American Society of Anesthesiologists (ASA) score of 4 (OR, 2.87; 95% CI, 1.21-6.83; P = 0.017), appendiceal histology (OR, 3.14; 95% CI 1.57-6.28; P = 0.001), smoking history (OR, 3.22; 95% CI, 1.70-6.12; P < 0.001), postoperative total parenteral nutrition (OR, 3.14; 95% CI, 1.70-5.81; P < 0.001), respiratory complications (OR, 7.40; 95% CI, 3.36-16.31; P < 0.001), wound site infections (OR, 3.12; 95% CI, 1.58-6.17; P = 0.001), preoperative hemoglobin (OR, 0.81; 95% CI, 0.70-0.94; P = 0.006), and total number of complications (OR, 1.41; 95% CI, 1.16-1.73; P < 0.001). Conclusions: Early identification of patients at high risk for NHD after CRS/HIPEC is key for preoperative and postoperative counseling and resource allocation, as well as minimizing hospital-acquired conditions and associated health care costs.
KW - Cancer
KW - Cytoreductive surgery
KW - Destination
KW - Discharge
KW - HIPEC
KW - Rehab
KW - Value-based
UR - http://www.scopus.com/inward/record.url?scp=85087132508&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85087132508&partnerID=8YFLogxK
U2 - 10.1016/j.jss.2020.05.085
DO - 10.1016/j.jss.2020.05.085
M3 - Article
C2 - 32622162
AN - SCOPUS:85087132508
SN - 0022-4804
VL - 255
SP - 475
EP - 485
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -