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Predictors of Non-home Discharge after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
Boateng Kubi1, Jonathan Gunn1, Nadege Fackche1
1Department of Surgery, Johns Hopkins University, Baltimore, Maryland.
Insights
Advanced age, smoking history, and complications like respiratory issues and infections predict nonhome discharge after cytoreductive surgery and HIPEC. Identifying these risk factors aids in patient counseling and resource allocation.
Area of Science:
- Oncology
- Surgical Oncology
- Clinical Outcomes Research
Background:
- Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a complex procedure for peritoneal malignancies.
- Nonhome discharge (NHD) after CRS/HIPEC represents a significant burden on patients and healthcare systems.
Purpose of the Study:
- To identify independent risk factors associated with nonhome discharge (NHD) in patients undergoing CRS/HIPEC.
- To inform preoperative and postoperative patient management and resource allocation.
Main Methods:
- A retrospective analysis of a national database of CRS/HIPEC recipients from 2000 to 2017.
- Univariate and multivariate logistic regression analyses were employed to determine predictors of NHD.
Main Results:
- The study included 1593 patients, with 4.4% experiencing NHD.
- Independent predictors of NHD included advanced age, American Society of Anesthesiologists (ASA) score of 4, appendiceal histology, smoking history, postoperative total parenteral nutrition, respiratory complications, and wound site infections.
- Preoperative hemoglobin and the total number of complications were also significant predictors.
Conclusions:
- Early identification of patients at high risk for NHD is crucial for optimizing care.
- Identifying these risk factors can improve preoperative and postoperative counseling, resource allocation, and potentially reduce healthcare costs and hospital-acquired conditions.
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.
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