National trends in discharge disposition after hepatic resection for malignancy
Bhavin C Shah1, Fred Ullrich, Lynette Smith
1Division of Surgical Oncology, Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198-3280, USA.
Background:
There is a paucity of data on the trends in discharge disposition for patients undergoing hepatic resection for malignancy.
Aim:
To analyse the national trends in discharge disposition after hepatic resection for malignancy.
Methods:
The National Inpatient Sample (NIS) database was queried (1993 to 2005) to identify patients that underwent hepatic resection for malignancy and analyse the discharge status (home, home health or rehabilitation/skilled facility).
Results:
A weighted total of 74,520 patients underwent hepatic resection of whom, 53,770 patients had a principal diagnosis of malignancy. The overall mortality improved from 6.3% to 3.4%. After excluding patients that died in the post-operative period and those with incomplete discharge status, 45,583 patients were included. The proportion of patients that had acute care needs preventing them from being discharged home without assistance increased from 10.9% in 1993 to 19.5% in 2005. While there was an increase in the number of patients discharged to home health care during this time (8.9% to 13.8%), there was a larger increase in the proportion of patients that were discharged to a rehabilitation or skilled nursing facility (2% to 5.7%). Despite a decrease in the mortality rates, there was no improvement in rate of patients discharged home without assistance over the period of the study.
Conclusions:
The results of the present study demonstrate that after hepatic resection, a significant proportion of patients will need assistance upon discharge. This information needs to be included in patient counselling during pre-operative risk and benefit assessment.
