Notice: Users may be experiencing issues with displaying some pages on stanfordhealthcare.org. We are working closely with our technical teams to resolve the issue as quickly as possible. Thank you for your patience.
 

See our updated masking policy »

Stanford Health Care

Predictors of Nonhome Discharge after Cytoreductive Surgery and HIPEC. The Journal of surgical research Kubi, B. n., Gunn, J. n., Fackche, N. n., Cloyd, J. M., Abdel-Misih, S. n., Grotz, T. n., Leiting, J. n., Fournier, K. n., Lee, A. J., Dineen, S. n., Dessureault, S. n., Veerapong, J. n., Baumgartner, J. M., Clarke, C. n., Mogal, H. n., Patel, S. H., Dhar, V. n., Lambert, L. n., Hendrix, R. J., Abbott, D. E., Pokrzywa, C. n., Raoof, M. n., Lee, B. n., Maithel, S. K., Staley, C. A., Johnston, F. M., Wang, N. Y., Greer, J. B. 2020; 255: 475–85

Abstract

Using a national database of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) recipients, we sought to determine risk factors for nonhome discharge (NHD) in a cohort of patients.Patients undergoing CRS/HIPEC at any one of 12 participating sites between 2000 and 2017 were identified. Univariate analysis was used to compare the characteristics, operative variables, and postoperative complications of patients discharged home and patients with NHD. Multivariate logistic regression was used to identify independent risk factors of NHD.The cohort included 1593 patients, of which 70 (4.4%) had an NHD. The median [range] peritoneal cancer index in our cohort was 14 [0-39]. Significant predictors of NHD identified in our regression analysis were advanced age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.05-1.12; P < 0.001), an American Society of Anesthesiologists (ASA) score of 4 (OR, 2.87; 95% CI, 1.21-6.83; P = 0.017), appendiceal histology (OR, 3.14; 95% CI 1.57-6.28; P = 0.001), smoking history (OR, 3.22; 95% CI, 1.70-6.12; P < 0.001), postoperative total parenteral nutrition (OR, 3.14; 95% CI, 1.70-5.81; P < 0.001), respiratory complications (OR, 7.40; 95% CI, 3.36-16.31; P < 0.001), wound site infections (OR, 3.12; 95% CI, 1.58-6.17; P = 0.001), preoperative hemoglobin (OR, 0.81; 95% CI, 0.70-0.94; P = 0.006), and total number of complications (OR, 1.41; 95% CI, 1.16-1.73; P < 0.001).Early identification of patients at high risk for NHD after CRS/HIPEC is key for preoperative and postoperative counseling and resource allocation, as well as minimizing hospital-acquired conditions and associated health care costs.

View details for DOI 10.1016/j.jss.2020.05.085

View details for PubMedID 32622162