Non-Home Discharge and Prolonged Length of Stay after Cytoreductive Surgery and HIPEC



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INTRODUCTION: The ability to preoperatively anticipate prolonged length of stay (PLOS) or transition to an extended care facility (non-home discharge, i.e., NHD) may facilitate discussion of patient expectations and improve utilization of hospital resources. No data has been reported on the rate and risk factors associated with NHD and PLOS in patients following cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for peritoneal carcinomatosis. The aim of this study is to identify risk factors for NHD and PLOS following CRS/HIPEC in a national cohort of patients. METHODS: Patients that underwent CRS/HIPEC from 2011-2012 were identified from the National Surgical Quality Improvement Project (NSQIP) dataset. NHD/PLOS and home discharge (within 30 days) groups were compared using Pearsonメs chi-squared test and two-sample t-test with unequal variances. A univariate analysis was used to compare patient demographics, diagnosis, comorbidities, CCI, operative details and types of resection and post-operative complications among both groups. A multivariate analysis was used to identify independent predictors of NHD and PLOS. RESULTS: A total of 556 CRS/HIPEC patients were identified, 44 (7.9%) of which were not discharged to home within 30 days. From these 44 patients, 12 were discharged to a skilled care facility and 11 were discharged to a rehabilitation facility, accounting for a NHD rate of 4.1%. Twenty-one patients remained hospitalized at ~30 days accounting for a PLOS rate of 3.7% On univariate analysis, advancing age, COPD, HTN, and low preoperative albumin were identified as preoperative risk factors for NHD/PLOS (p<0.05). On multivariate analysis, age ≥ 65, pre-op albumin < 3.0 g/dL, and having a multi-visceral resection were identified as independent predictors of NHD/PLOS. If all three predictors are met preoperatively, the probability of NHD/PLOS is 30.2%. CONCLUSION: In this national cohort of patients, advanced age, hypoalbuminemia, and multi-visceral resection constituted the main risk factors for NHD/PLOS following CRS/HIPEC. Timely identification of these risk factors may facilitate preoperative discussions with patients, and improve discharge planning and resource utilization.

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The 56th Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, January 23, 2018, 2-5 p.m., D1.600)

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Clinical Research, Cytoreduction Surgical Procedures, Hyperthermia, Induced, Length of Stay, Patient Discharge, Peritoneal Neoplasms, Quality Improvement


Burguete, D., Mokdad, A. A., Augustine, M. M., Minter, R., Mansour, J. C., Choti, M. A., & Polanco, P. (2018, January 23). Non-home discharge and prolonged length of stay after cytoreductive surgery and HIPEC. Poster session presented at the 56th Annual Medical Student Research Forum, Dallas, TX. Retrieved from

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