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Hospitalization in the Year Preceding Major Oncologic Surgery Increases Risk for Adverse Postoperative Events

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Hospitalization is associated with negative clinical effects that last beyond discharge. This study aimed to determine whether hospitalization in the year before major oncologic surgery is associated with adverse outcomes.

Methods

Patients 18 years of age or older with stomach, pancreas, colon, or rectal cancer who underwent resection in California and New York (2008–2010) were included in the study. Patients with hospitalization in the year prior to oncologic resection (HYPOR) were identified. Multivariable logistic regression was used to examine the association of prior hospitalization with the following adverse outcomes: inpatient mortality, complications, complex discharge needs, and 90-day readmission. Subset analysis by cancer type was performed. Outcomes based on temporal proximity of hospitalization to month of surgical admission were evaluated.

Results

Of 32,292 patients, 16.3% (n = 5276) were HYPOR. Patients with prior hospitalization were older (median age, 72 vs 67 years; p < 0.001) and had more comorbidities (Elixhauser Index ≥3, 86.5 vs 75.3%; p < 0.001). In the multivariable analysis, HYPOR was associated with complications (odds ratio [OR], 1.28; 95% confidence interval [CI] 1.18–1.40), complex discharge (OR, 1.44; 95% CI 1.34–1.55), and 90-day readmission (OR, 1.45; 95% CI 1.35–1.56). The interval from HYPOR to resection was not associated with adverse outcomes.

Conclusions

Patients hospitalized in the year before oncologic resection are at increased risk for postoperative adverse events. Recent hospitalization is a risk factor that is easily ascertainable and should be used by clinicians to identify patients who may need additional support around the time of oncologic resection.

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Conflict of interest

There are no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgery, Center for Surgery and Health Economics, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Catherine E. Sharoky MD, Karole T. Collier BS, Christopher J. Wirtalla BA, Andrew J. Sinnamon MD, Madalyn G. Neuwirth MD, Lindsay E. Kuo MD, MBA, Giorgos C. Karakousis MD & Rachel R. Kelz MD, MSCE

  2. Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Robert E. Roses MD, Douglas L. Fraker MD, Giorgos C. Karakousis MD & Rachel R. Kelz MD, MSCE

Authors
  1. Catherine E. Sharoky MD
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  2. Karole T. Collier BS
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  3. Christopher J. Wirtalla BA
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  4. Andrew J. Sinnamon MD
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  5. Madalyn G. Neuwirth MD
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  6. Lindsay E. Kuo MD, MBA
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  7. Robert E. Roses MD
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  8. Douglas L. Fraker MD
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  10. Rachel R. Kelz MD, MSCE
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Correspondence to Catherine E. Sharoky MD.

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Sharoky, C.E., Collier, K.T., Wirtalla, C.J. et al. Hospitalization in the Year Preceding Major Oncologic Surgery Increases Risk for Adverse Postoperative Events. Ann Surg Oncol 24, 3477–3485 (2017). https://doi.org/10.1245/s10434-017-6032-y

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  • DOI: https://doi.org/10.1245/s10434-017-6032-y

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