Increased Rates of Prolonged Length of Stay, Readmissions, and Discharge to Care Facilities among Postoperative Patients with Disseminated Malignancy: Implications for Clinical Practice

• Published in: PloS one Vol. 11; no. 10; p. e0165315
• Main Authors: Bateni, Sarah B, Meyers, Frederick J, Bold, Richard J, Canter, Robert J
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 25.10.2016; Public Library of Science (PLoS)
• Subjects: Abdomen; Adult; Aged; Cancer; Cancer surgery; Cancer therapies; Colorectal cancer; Complications; Computer programs; Discharge; Embolisms; Emergency medical care; End of life; Female; Health aspects; Hospitals; Humans; Infections; Intestine; Intubation; Length of Stay; Male; Malignancy; Medical care quality; Medical personnel; Medical prognosis; Medical research; Medicine and Health Sciences; Metastasis; Middle Aged; Morbidity; Mortality; Neoplasms - epidemiology; Neoplasms - mortality; Neoplasms - surgery; Nursing; Odds Ratio; Oncology; Palliative care; Patient Discharge; Patient Readmission; Patients; Postoperative Period; Proportional Hazards Models; Quality control; Quality of life; Regression analysis; Regression models; Sepsis; Statistics; Subgroups; Surgeons; Surgery; Surgical outcomes; Survival Rate; Treatment Outcome; Variables; Sacramento California; United States > US; California
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0165315

The impact of surgery on end of life care for patients with disseminated malignancy (DMa) is incompletely characterized. The purpose of this study was to evaluate postoperative outcomes impacting quality of care among DMa patients, specifically prolonged length of hospital stay, readmission, and disposition. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for years 2011-2012. DMa patients were matched to non-DMa patients with comparable clinical characteristics and operation types. Primary hepatic operations were excluded, leaving a final cohort of 17,972 DMa patients. The primary outcomes were analyzed using multivariate Cox regression models. DMa patients represented 2.1% of all ACS-NSQIP procedures during the study period. The most frequent operations were bowel resections (25.3%). Compared to non-DMa matched controls, DMa patients had higher rates of postoperative overall morbidity (24.4% vs. 18.7%, p<0.001), serious morbidity (14.9% vs. 12.0%, p<0.001), mortality (7.6% vs. 2.5%, p<0.001), prolonged length of stay (32.2% vs. 19.8%, p<0.001), readmission (15.7% vs. 9.6%, p<0.001), and discharges to facilities (16.2% vs. 12.9%, p<0.001). Subgroup analyses of patients by procedure type showed similar results. Importantly, DMa patients who did not experience any postoperative complication experienced significantly higher rates of prolonged length of stay (23.0% vs. 11.8%, p<0.001), readmissions (10.0% vs. 5.2%, p<0.001), discharges to a facility (13.2% vs. 9.5%, p<0.001), and 30-day mortality (4.7% vs. 0.8%, p<0.001) compared to matched non-DMa patients. Surgical interventions among DMa patients are associated with poorer postoperative outcomes including greater postoperative complications, prolonged length of hospital stay, readmissions, disposition to facilities, and death compared to non-DMa patients. These data reinforce the importance of clarifying goals of care for DMa patients, especially when acute changes in health status potentially requiring surgery occur.