Non-home Discharge and Prolonged Length of Stay After Cytoreductive Surgery and HIPEC

J Surg Res. 2019 Jan;233:360-367. doi: 10.1016/j.jss.2018.08.018. Epub 2018 Sep 8.

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.

MeSH terms

  • Age Factors
  • Aged
  • Combined Modality Therapy / adverse effects
  • Combined Modality Therapy / methods
  • Cytoreduction Surgical Procedures / adverse effects*
  • Female
  • Humans
  • Hyperthermia, Induced / adverse effects*
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Patient Discharge / statistics & numerical data*
  • Peritoneal Neoplasms / therapy*
  • Peritoneum / surgery
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Postoperative Complications / therapy
  • Prognosis
  • Risk Assessment / methods
  • Risk Factors
  • Skilled Nursing Facilities / statistics & numerical data
  • Transitional Care / statistics & numerical data
  • Treatment Outcome
  • United States / epidemiology