Readmission Following Gastric Cancer Resection

Risk Factors and Survival

Alexandra W. Acher, Malcolm H. Squires, Ryan C. Fields, George A. Poultsides, Carl Schmidt, Konstantinos I. Votanopoulos, Timothy M. Pawlik, Linda X. Jin, Aslam Ejaz, David A. Kooby, Mark Bloomston, David Worhunsky, Edward A. Levine, Neil Saunders, Emily Winslow, Clifford S. Cho, Glen Leverson, Shishir K. Maithel, Sharon M. Weber

Research output: Contribution to journalArticle

Abstract

Background: This study utilized a multi-institutional database to evaluate risk factors for readmission in patients undergoing curative gastrectomy for gastric adenocarcinoma with the intent of describing both perioperative risk factors and the relationship of readmission to survival. Methods: Patients who underwent curative resection of gastric adenocarcinoma from 2000 to 2012 from seven academic institutions of the US Gastric Cancer Collaborative were analyzed. In-hospital deaths and palliative surgeries were excluded, and readmission was defined as within 30 days of discharge. Univariate and multivariable logistic regression analyses were employed and survival analysis conducted. Results: Of the 855 patients, 121 patients (14.2 %) were readmitted. Univariate analysis identified advanced age (p <0.0128), American Society of Anesthesiology status ≥3 (p = 0.0045), preexisting cardiac disease (p <0.0001), hypertension (p = 0.0142), history of smoking (p = 0.0254), increased preoperative blood urea nitrogen (BUN; p = 0.0426), concomitant pancreatectomy (p = 0.0056), increased operation time (p = 0.0384), estimated blood loss (p = 0.0196), 25th percentile length of stay (12 days, p = 0.0256), postoperative complication (p <0.0001), and total gastrectomy (p = 0.0167) as risk factors for readmission. Multivariable analysis identified cardiac disease (odds ratio (OR) 2.4, 95 % confidence interval (CI) 1.6–3.3, p <0.0001), postoperative complication (OR 2.3, 95 % CI 1.6–5.4, p <0.0001), and pancreatectomy (OR 2.2, 95 % CI 1.1–4.1, p = 0.0202) as independent risk factors for readmission. There was an association of decreased overall median survival in readmitted patients (39 months for readmitted vs. 103 months for non-readmitted). This was due to decreased survival in readmitted stage 1 (p = 0.0039), while there was no difference in survival for other stages. Stage I readmitted patients had a higher incidence of cardiac disease than stage I non-readmitted patients (58 vs. 24 %, respectively, p = 0.0002). Conclusions: Within this multi-institutional study investigating readmission in patients undergoing curative resection for gastric cancer, cardiac disease, postoperative complication, and concomitant pancreatectomy were identified as significant risk factors for readmission. Readmission was associated with decreased overall median survival, but on further analysis, this was driven by differences in survival for stage I disease only.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Apr 21 2016

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Stomach Neoplasms
Pancreatectomy
Survival
Heart Diseases
Patient Readmission
Blood Urea Nitrogen
Odds Ratio
Confidence Intervals
Gastrectomy
Stomach
Adenocarcinoma
Preexisting Condition Coverage
Anesthesiology
Survival Analysis
Palliative Care
Length of Stay
Logistic Models
Smoking
Regression Analysis
Databases

Keywords

  • Adenocarcinoma
  • Gastrectomy
  • Gastric cancer
  • Readmission
  • Risk factors
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Acher, A. W., Squires, M. H., Fields, R. C., Poultsides, G. A., Schmidt, C., Votanopoulos, K. I., ... Weber, S. M. (Accepted/In press). Readmission Following Gastric Cancer Resection: Risk Factors and Survival. Journal of Gastrointestinal Surgery, 1-11. https://doi.org/10.1007/s11605-015-3070-2

Readmission Following Gastric Cancer Resection : Risk Factors and Survival. / Acher, Alexandra W.; Squires, Malcolm H.; Fields, Ryan C.; Poultsides, George A.; Schmidt, Carl; Votanopoulos, Konstantinos I.; Pawlik, Timothy M.; Jin, Linda X.; Ejaz, Aslam; Kooby, David A.; Bloomston, Mark; Worhunsky, David; Levine, Edward A.; Saunders, Neil; Winslow, Emily; Cho, Clifford S.; Leverson, Glen; Maithel, Shishir K.; Weber, Sharon M.

In: Journal of Gastrointestinal Surgery, 21.04.2016, p. 1-11.

Research output: Contribution to journalArticle

Acher, AW, Squires, MH, Fields, RC, Poultsides, GA, Schmidt, C, Votanopoulos, KI, Pawlik, TM, Jin, LX, Ejaz, A, Kooby, DA, Bloomston, M, Worhunsky, D, Levine, EA, Saunders, N, Winslow, E, Cho, CS, Leverson, G, Maithel, SK & Weber, SM 2016, 'Readmission Following Gastric Cancer Resection: Risk Factors and Survival', Journal of Gastrointestinal Surgery, pp. 1-11. https://doi.org/10.1007/s11605-015-3070-2
Acher AW, Squires MH, Fields RC, Poultsides GA, Schmidt C, Votanopoulos KI et al. Readmission Following Gastric Cancer Resection: Risk Factors and Survival. Journal of Gastrointestinal Surgery. 2016 Apr 21;1-11. https://doi.org/10.1007/s11605-015-3070-2
Acher, Alexandra W. ; Squires, Malcolm H. ; Fields, Ryan C. ; Poultsides, George A. ; Schmidt, Carl ; Votanopoulos, Konstantinos I. ; Pawlik, Timothy M. ; Jin, Linda X. ; Ejaz, Aslam ; Kooby, David A. ; Bloomston, Mark ; Worhunsky, David ; Levine, Edward A. ; Saunders, Neil ; Winslow, Emily ; Cho, Clifford S. ; Leverson, Glen ; Maithel, Shishir K. ; Weber, Sharon M. / Readmission Following Gastric Cancer Resection : Risk Factors and Survival. In: Journal of Gastrointestinal Surgery. 2016 ; pp. 1-11.
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abstract = "Background: This study utilized a multi-institutional database to evaluate risk factors for readmission in patients undergoing curative gastrectomy for gastric adenocarcinoma with the intent of describing both perioperative risk factors and the relationship of readmission to survival. Methods: Patients who underwent curative resection of gastric adenocarcinoma from 2000 to 2012 from seven academic institutions of the US Gastric Cancer Collaborative were analyzed. In-hospital deaths and palliative surgeries were excluded, and readmission was defined as within 30 days of discharge. Univariate and multivariable logistic regression analyses were employed and survival analysis conducted. Results: Of the 855 patients, 121 patients (14.2 {\%}) were readmitted. Univariate analysis identified advanced age (p <0.0128), American Society of Anesthesiology status ≥3 (p = 0.0045), preexisting cardiac disease (p <0.0001), hypertension (p = 0.0142), history of smoking (p = 0.0254), increased preoperative blood urea nitrogen (BUN; p = 0.0426), concomitant pancreatectomy (p = 0.0056), increased operation time (p = 0.0384), estimated blood loss (p = 0.0196), 25th percentile length of stay (12 days, p = 0.0256), postoperative complication (p <0.0001), and total gastrectomy (p = 0.0167) as risk factors for readmission. Multivariable analysis identified cardiac disease (odds ratio (OR) 2.4, 95 {\%} confidence interval (CI) 1.6–3.3, p <0.0001), postoperative complication (OR 2.3, 95 {\%} CI 1.6–5.4, p <0.0001), and pancreatectomy (OR 2.2, 95 {\%} CI 1.1–4.1, p = 0.0202) as independent risk factors for readmission. There was an association of decreased overall median survival in readmitted patients (39 months for readmitted vs. 103 months for non-readmitted). This was due to decreased survival in readmitted stage 1 (p = 0.0039), while there was no difference in survival for other stages. Stage I readmitted patients had a higher incidence of cardiac disease than stage I non-readmitted patients (58 vs. 24 {\%}, respectively, p = 0.0002). Conclusions: Within this multi-institutional study investigating readmission in patients undergoing curative resection for gastric cancer, cardiac disease, postoperative complication, and concomitant pancreatectomy were identified as significant risk factors for readmission. Readmission was associated with decreased overall median survival, but on further analysis, this was driven by differences in survival for stage I disease only.",
keywords = "Adenocarcinoma, Gastrectomy, Gastric cancer, Readmission, Risk factors, Survival",
author = "Acher, {Alexandra W.} and Squires, {Malcolm H.} and Fields, {Ryan C.} and Poultsides, {George A.} and Carl Schmidt and Votanopoulos, {Konstantinos I.} and Pawlik, {Timothy M.} and Jin, {Linda X.} and Aslam Ejaz and Kooby, {David A.} and Mark Bloomston and David Worhunsky and Levine, {Edward A.} and Neil Saunders and Emily Winslow and Cho, {Clifford S.} and Glen Leverson and Maithel, {Shishir K.} and Weber, {Sharon M.}",
year = "2016",
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TY - JOUR

T1 - Readmission Following Gastric Cancer Resection

T2 - Risk Factors and Survival

AU - Acher, Alexandra W.

AU - Squires, Malcolm H.

AU - Fields, Ryan C.

AU - Poultsides, George A.

AU - Schmidt, Carl

AU - Votanopoulos, Konstantinos I.

AU - Pawlik, Timothy M.

AU - Jin, Linda X.

AU - Ejaz, Aslam

AU - Kooby, David A.

AU - Bloomston, Mark

AU - Worhunsky, David

AU - Levine, Edward A.

AU - Saunders, Neil

AU - Winslow, Emily

AU - Cho, Clifford S.

AU - Leverson, Glen

AU - Maithel, Shishir K.

AU - Weber, Sharon M.

PY - 2016/4/21

Y1 - 2016/4/21

N2 - Background: This study utilized a multi-institutional database to evaluate risk factors for readmission in patients undergoing curative gastrectomy for gastric adenocarcinoma with the intent of describing both perioperative risk factors and the relationship of readmission to survival. Methods: Patients who underwent curative resection of gastric adenocarcinoma from 2000 to 2012 from seven academic institutions of the US Gastric Cancer Collaborative were analyzed. In-hospital deaths and palliative surgeries were excluded, and readmission was defined as within 30 days of discharge. Univariate and multivariable logistic regression analyses were employed and survival analysis conducted. Results: Of the 855 patients, 121 patients (14.2 %) were readmitted. Univariate analysis identified advanced age (p <0.0128), American Society of Anesthesiology status ≥3 (p = 0.0045), preexisting cardiac disease (p <0.0001), hypertension (p = 0.0142), history of smoking (p = 0.0254), increased preoperative blood urea nitrogen (BUN; p = 0.0426), concomitant pancreatectomy (p = 0.0056), increased operation time (p = 0.0384), estimated blood loss (p = 0.0196), 25th percentile length of stay (12 days, p = 0.0256), postoperative complication (p <0.0001), and total gastrectomy (p = 0.0167) as risk factors for readmission. Multivariable analysis identified cardiac disease (odds ratio (OR) 2.4, 95 % confidence interval (CI) 1.6–3.3, p <0.0001), postoperative complication (OR 2.3, 95 % CI 1.6–5.4, p <0.0001), and pancreatectomy (OR 2.2, 95 % CI 1.1–4.1, p = 0.0202) as independent risk factors for readmission. There was an association of decreased overall median survival in readmitted patients (39 months for readmitted vs. 103 months for non-readmitted). This was due to decreased survival in readmitted stage 1 (p = 0.0039), while there was no difference in survival for other stages. Stage I readmitted patients had a higher incidence of cardiac disease than stage I non-readmitted patients (58 vs. 24 %, respectively, p = 0.0002). Conclusions: Within this multi-institutional study investigating readmission in patients undergoing curative resection for gastric cancer, cardiac disease, postoperative complication, and concomitant pancreatectomy were identified as significant risk factors for readmission. Readmission was associated with decreased overall median survival, but on further analysis, this was driven by differences in survival for stage I disease only.

AB - Background: This study utilized a multi-institutional database to evaluate risk factors for readmission in patients undergoing curative gastrectomy for gastric adenocarcinoma with the intent of describing both perioperative risk factors and the relationship of readmission to survival. Methods: Patients who underwent curative resection of gastric adenocarcinoma from 2000 to 2012 from seven academic institutions of the US Gastric Cancer Collaborative were analyzed. In-hospital deaths and palliative surgeries were excluded, and readmission was defined as within 30 days of discharge. Univariate and multivariable logistic regression analyses were employed and survival analysis conducted. Results: Of the 855 patients, 121 patients (14.2 %) were readmitted. Univariate analysis identified advanced age (p <0.0128), American Society of Anesthesiology status ≥3 (p = 0.0045), preexisting cardiac disease (p <0.0001), hypertension (p = 0.0142), history of smoking (p = 0.0254), increased preoperative blood urea nitrogen (BUN; p = 0.0426), concomitant pancreatectomy (p = 0.0056), increased operation time (p = 0.0384), estimated blood loss (p = 0.0196), 25th percentile length of stay (12 days, p = 0.0256), postoperative complication (p <0.0001), and total gastrectomy (p = 0.0167) as risk factors for readmission. Multivariable analysis identified cardiac disease (odds ratio (OR) 2.4, 95 % confidence interval (CI) 1.6–3.3, p <0.0001), postoperative complication (OR 2.3, 95 % CI 1.6–5.4, p <0.0001), and pancreatectomy (OR 2.2, 95 % CI 1.1–4.1, p = 0.0202) as independent risk factors for readmission. There was an association of decreased overall median survival in readmitted patients (39 months for readmitted vs. 103 months for non-readmitted). This was due to decreased survival in readmitted stage 1 (p = 0.0039), while there was no difference in survival for other stages. Stage I readmitted patients had a higher incidence of cardiac disease than stage I non-readmitted patients (58 vs. 24 %, respectively, p = 0.0002). Conclusions: Within this multi-institutional study investigating readmission in patients undergoing curative resection for gastric cancer, cardiac disease, postoperative complication, and concomitant pancreatectomy were identified as significant risk factors for readmission. Readmission was associated with decreased overall median survival, but on further analysis, this was driven by differences in survival for stage I disease only.

KW - Adenocarcinoma

KW - Gastrectomy

KW - Gastric cancer

KW - Readmission

KW - Risk factors

KW - Survival

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U2 - 10.1007/s11605-015-3070-2

DO - 10.1007/s11605-015-3070-2

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JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

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