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Factors Predicting Readmission and Mortality in Patients Admitted for Malignant Bowel Obstruction
Nova Xu1, Beatrice J Sun2, Tiffany M Yue1
1Stanford University School of Medicine, Stanford, CA, USA.
Introduction:
Malignant bowel obstruction (MBO) is a common complication of patients with advanced malignancies and has poor prognosis. Currently, there are limited guidelines for MBO management or predicting outcomes for these patients.
Objective:
To identify patient factors associated with readmission and mortality after hospital admission for MBO.
Participants:
A 5-year retrospective review was performed from 2017 to 2022 at a single tertiary institution to evaluate patients admitted for MBO. All patients had advanced cancer of gastrointestinal or gynecologic primary. Patient demographics, socioeconomic factors, tumor characteristics, and inpatient outcomes were collected. Multivariable analyses were performed to determine variables predicting hospital readmission for recurrent MBO and 90-day mortality.
Results:
210 patients were included. Mean age was 61 years, 28% were male, and 19% did not primarily speak English. 35% of patients lived over 50 miles from the hospital. On multivariable analysis, non-English speaking patients exhibited increased risk of readmission for MBO (OR = 2.82, P = .039). Older age was associated with decreased risk for MBO readmission (OR = .96, P = .007). Ascites was associated with increased mortality (OR = 2.17, P = .043). Earlier palliative care (PC) consultation predicted decreased readmission (OR = .24, P < .001) yet increased mortality at 90 days (OR = 3.20, P = .003).
Conclusion:
Patient age, primary language, and PC consult were predictors for MBO readmission, which may impact 90-day mortality. Given the palliative nature of MBO, modifiable factors such as PC consultation and multidisciplinary goals of care discussions should be prioritized in order to reduce readmissions and focus on quality of life (QOL) for this patient population.
Insights
Malignant bowel obstruction (MBO) readmission is influenced by patient age and language. Early palliative care consultation impacts readmission and mortality, highlighting the need for multidisciplinary discussions to improve quality of life.
Area of Science:
- Oncology
- Palliative Care
- Health Services Research
Background:
- Malignant bowel obstruction (MBO) is a frequent complication in advanced cancer patients, often associated with a poor prognosis.
- Current management guidelines and outcome prediction for MBO are limited.
- Identifying factors influencing MBO patient outcomes is crucial for improving care.
Purpose of the Study:
- To identify patient-specific factors associated with hospital readmission after MBO.
- To determine patient characteristics linked to 90-day mortality following MBO admission.
- To explore the impact of palliative care consultation on MBO outcomes.
Main Methods:
- A 5-year retrospective review (2017-2022) of patients with advanced gastrointestinal or gynecologic malignancies admitted for MBO.
- Data collection included demographics, socioeconomic status, tumor characteristics, and inpatient outcomes.
- Multivariable analyses were conducted to identify predictors of readmission and 90-day mortality.
Main Results:
- Non-English speaking patients had a significantly higher risk of MBO readmission (OR=2.82, P=.039).
- Older age was associated with a decreased risk of MBO readmission (OR=0.96, P=.007), while ascites increased mortality risk (OR=2.17, P=.043).
- Early palliative care (PC) consultation predicted lower readmission rates (OR=0.24, P<.001) but higher 90-day mortality (OR=3.20, P=.003).
Conclusions:
- Patient age, primary language, and palliative care (PC) consultation are significant predictors of MBO readmission and may influence 90-day mortality.
- Given the palliative nature of MBO, prioritizing PC consultation and multidisciplinary goals of care discussions is essential.
- These interventions can potentially reduce readmissions and enhance the quality of life for patients with MBO.
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