A Multi-State Cohort Study of Hospital Utilization and Treatment Modality for Malignant Gastrointestinal Obstructions

Malignant obstructions are associated with morbidity, mortality, and impaired quality of life with limited population-based data on practice patterns. We characterized the association between prior cancer-related hospitalizations and receipt of operative treatment for obstruction.

We performed a retrospective cohort study of patients hospitalized with malignant gastrointestinal obstructions from colorectal, gynecologic (GYN), and hepato-pancreatico-biliary (HPB) cancers in 12 states using the Healthcare Cost and Utilization Project State Inpatient Database, 2016-2020. The primary exposure was the number of cancer-related hospitalizations in the year prior to the first hospitalization for an obstruction. Risk-adjusted use of operative treatment during the index hospitalization, enrollment in hospice, length of stay, and inpatient mortality were examined using regression.

Of 8665 patients, the median age was 67 years [Interquartile Range: 58,76]. There were 3789 patients with colorectal (43.7%), 2593 patients with GYN (29.9%), and 2337 patients (26.9%) with HPB cancers. The operative rate was 24.1%. Patients with prior hospitalizations were less likely to undergo operative treatment than those who were not previously hospitalized (operative rate difference: -7.8%, p < 0.001). Operative treatment was associated with longer median length of stay ( + 8.6 days, p < 0.001), lower rates of hospice enrollment (-3.0%, p = 0.002) and lower rates of inpatient mortality (operative rate difference -2.3%, p < 0.001). The time between readmissions also decreased with each recurrent obstruction in colorectal and GYN cancers.

A greater number of previous cancer-related hospitalizations was associated with lower rates of operative treatment during the first hospitalization for a malignant obstruction. These data provide insight into the treatment trends for patients with malignant obstructions and may be helpful when counseling patients about the natural course of their disease.