Nonhome discharge and prolonged length of stay after cytoreductive surgery and HIPEC

Research output: Contribution to journalArticle

Abstract

Background: Predictive models for nonhome discharge (NHD) have been proposed in major surgical specialties. The rates and risk factors associated with NHD and prolonged length of stay (PLOS) after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) have not been evaluated. The aim of this study is to identify risk factors for NHD and PLOS after CRS/HIPEC in a national cohort of patients. Materials and Methods: CRS/HIPEC cases were identified from the National Surgical Quality Improvement Program 2011-2012 data set. Patients with an NHD or PLOS (>30 d) were compared with a group of patients discharged to home within 30 d. Univariate analysis was used to compare patient characteristics, operative variables, and postoperative complications among both groups. Multivariate regression analysis was used to identify independent predictors of NHD and PLOS. Results: Five hundred fifty-six patients undergoing CRS/HIPEC were identified, of which 44 (7.9%) were not discharged to home within 30 d. The rate of NHD and PLOS in this cohort was 4.1% and 3.7%, respectively. Multivariate analysis identified age ≥65 y, pre-op albumin <3.0 g/dL, and having a multivisceral resection as independent predictors of NHD/PLOS. If all three predictors are met preoperatively, the probability of NHD/PLOS was calculated to be 30.2%. Conclusions: The main risk factors for NHD/PLOS after CRS/HIPEC were advanced age, hypoalbuminemia, and multivisceral resection. Adequate identification of these risk factors may facilitate preoperative discussion with patients, and improve discharge planning and resource utilization.

LanguageEnglish (US)
Pages360-367
Number of pages8
JournalJournal of Surgical Research
Volume233
DOIs
StatePublished - Jan 1 2019

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Length of Stay
Drug Therapy
Patient Discharge
Multivariate Analysis
Surgical Specialties
Hypoalbuminemia
Quality Improvement
Albumins
Regression Analysis

Keywords

  • Cytoreductive surgery
  • Hyperthermic intraperitoneal chemotherapy
  • Nonhome discharge
  • Peritoneal carcinomatosis
  • Prolonged length of stay

ASJC Scopus subject areas

  • Surgery

Cite this

@article{5fd8cb947a6a452394cc142ac735ddf9,
title = "Nonhome discharge and prolonged length of stay after cytoreductive surgery and HIPEC",
abstract = "Background: Predictive models for nonhome discharge (NHD) have been proposed in major surgical specialties. The rates and risk factors associated with NHD and prolonged length of stay (PLOS) after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) have not been evaluated. The aim of this study is to identify risk factors for NHD and PLOS after CRS/HIPEC in a national cohort of patients. Materials and Methods: CRS/HIPEC cases were identified from the National Surgical Quality Improvement Program 2011-2012 data set. Patients with an NHD or PLOS (>30 d) were compared with a group of patients discharged to home within 30 d. Univariate analysis was used to compare patient characteristics, operative variables, and postoperative complications among both groups. Multivariate regression analysis was used to identify independent predictors of NHD and PLOS. Results: Five hundred fifty-six patients undergoing CRS/HIPEC were identified, of which 44 (7.9{\%}) were not discharged to home within 30 d. The rate of NHD and PLOS in this cohort was 4.1{\%} and 3.7{\%}, respectively. Multivariate analysis identified age ≥65 y, pre-op albumin <3.0 g/dL, and having a multivisceral resection as independent predictors of NHD/PLOS. If all three predictors are met preoperatively, the probability of NHD/PLOS was calculated to be 30.2{\%}. Conclusions: The main risk factors for NHD/PLOS after CRS/HIPEC were advanced age, hypoalbuminemia, and multivisceral resection. Adequate identification of these risk factors may facilitate preoperative discussion with patients, and improve discharge planning and resource utilization.",
keywords = "Cytoreductive surgery, Hyperthermic intraperitoneal chemotherapy, Nonhome discharge, Peritoneal carcinomatosis, Prolonged length of stay",
author = "Daniel Burguete and Mokdad, {Ali A.} and Augustine, {Mathew M.} and Rebecca Minter and Mansour, {John C.} and Choti, {Michael A.} and Polanco, {Patricio M.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jss.2018.08.018",
language = "English (US)",
volume = "233",
pages = "360--367",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Nonhome discharge and prolonged length of stay after cytoreductive surgery and HIPEC

AU - Burguete, Daniel

AU - Mokdad, Ali A.

AU - Augustine, Mathew M.

AU - Minter, Rebecca

AU - Mansour, John C.

AU - Choti, Michael A.

AU - Polanco, Patricio M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Predictive models for nonhome discharge (NHD) have been proposed in major surgical specialties. The rates and risk factors associated with NHD and prolonged length of stay (PLOS) after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) have not been evaluated. The aim of this study is to identify risk factors for NHD and PLOS after CRS/HIPEC in a national cohort of patients. Materials and Methods: CRS/HIPEC cases were identified from the National Surgical Quality Improvement Program 2011-2012 data set. Patients with an NHD or PLOS (>30 d) were compared with a group of patients discharged to home within 30 d. Univariate analysis was used to compare patient characteristics, operative variables, and postoperative complications among both groups. Multivariate regression analysis was used to identify independent predictors of NHD and PLOS. Results: Five hundred fifty-six patients undergoing CRS/HIPEC were identified, of which 44 (7.9%) were not discharged to home within 30 d. The rate of NHD and PLOS in this cohort was 4.1% and 3.7%, respectively. Multivariate analysis identified age ≥65 y, pre-op albumin <3.0 g/dL, and having a multivisceral resection as independent predictors of NHD/PLOS. If all three predictors are met preoperatively, the probability of NHD/PLOS was calculated to be 30.2%. Conclusions: The main risk factors for NHD/PLOS after CRS/HIPEC were advanced age, hypoalbuminemia, and multivisceral resection. Adequate identification of these risk factors may facilitate preoperative discussion with patients, and improve discharge planning and resource utilization.

AB - Background: Predictive models for nonhome discharge (NHD) have been proposed in major surgical specialties. The rates and risk factors associated with NHD and prolonged length of stay (PLOS) after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) have not been evaluated. The aim of this study is to identify risk factors for NHD and PLOS after CRS/HIPEC in a national cohort of patients. Materials and Methods: CRS/HIPEC cases were identified from the National Surgical Quality Improvement Program 2011-2012 data set. Patients with an NHD or PLOS (>30 d) were compared with a group of patients discharged to home within 30 d. Univariate analysis was used to compare patient characteristics, operative variables, and postoperative complications among both groups. Multivariate regression analysis was used to identify independent predictors of NHD and PLOS. Results: Five hundred fifty-six patients undergoing CRS/HIPEC were identified, of which 44 (7.9%) were not discharged to home within 30 d. The rate of NHD and PLOS in this cohort was 4.1% and 3.7%, respectively. Multivariate analysis identified age ≥65 y, pre-op albumin <3.0 g/dL, and having a multivisceral resection as independent predictors of NHD/PLOS. If all three predictors are met preoperatively, the probability of NHD/PLOS was calculated to be 30.2%. Conclusions: The main risk factors for NHD/PLOS after CRS/HIPEC were advanced age, hypoalbuminemia, and multivisceral resection. Adequate identification of these risk factors may facilitate preoperative discussion with patients, and improve discharge planning and resource utilization.

KW - Cytoreductive surgery

KW - Hyperthermic intraperitoneal chemotherapy

KW - Nonhome discharge

KW - Peritoneal carcinomatosis

KW - Prolonged length of stay

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U2 - 10.1016/j.jss.2018.08.018

DO - 10.1016/j.jss.2018.08.018

M3 - Article

VL - 233

SP - 360

EP - 367

JO - Journal of Surgical Research

T2 - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

ER -