Readmissions After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: a US HIPEC Collaborative Study

Tiffany C. Lee, Koffi Wima, Jeffrey J. Sussman, Syed A. Ahmad, Jordan M. Cloyd, Ahmed Ahmed, Keith Fournier, Andrew J. Lee, Sean Dineen, Benjamin Powers, Jula Veerapong, Joel M. Baumgartner, Callisia Clarke, Harveshp Mogal, Mohammad Y. Zaidi, Shishir K. Maithel, Jennifer Leiting, Travis Grotz, Laura Lambert, Ryan J. HendrixDaniel E. Abbott, Courtney Pokrzywa, Andrew M. Blakely, Byrne Lee, Fabian M. Johnston, Jonathan Greer, Sameer H. Patel

Research output: Contribution to journalArticle

Abstract

Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) results in significant morbidity and readmissions. Previous studies have been limited by single-institution design or lack of tumor details in the database used. Methods: The 12-institution US HIPEC Collaborative Database was queried between 1999 and 2017. Preoperative and intraoperative patient and tumor details were analyzed for associations with readmissions. Results: A total of 2017 of 2372 cases were included in the analysis. The 30-day readmission rate was 15.9% (n = 321). Common indications for readmission included failure to thrive (29.9%), infection (23.6%), and ileus/bowel obstruction (15.1%). The readmitted cohort had more complications, including intra-abdominal abscess (21.2% vs 6.2%), ileus (28.0% vs 17.2%), anastomotic leak (11.2% vs 2.2%), enteric fistula (5.6% vs 1.5%), deep venous thrombosis (6.2% vs 2.5%), and pulmonary embolism (6.9% vs 2.5%). Factors independently associated with readmission (p < 0.05) included ECOG score ≥ 3 (OR 3.4), depression (OR 2.4), total parenteral nutrition (OR 3.6), low anterior resection or partial colectomy (OR 2.0), and stoma creation (OR 2.2). Factors not associated included neoadjuvant chemotherapy, peritoneal cancer index, and completeness of cytoreduction. Readmission rate between 31 and 90 days was 3.9% (n = 78). Independent predictors (p < 0.05) included operative time (OR 1.1), low anterior resection or partial colectomy (OR 1.7), and stoma creation (OR 2.2). Conclusions: In the largest study to date examining readmissions after CRS-HIPEC, 30-day readmission rate was 15.9%. Tumor factors failed to predict readmission, whereas preoperative functional status and depression along with individual cytoreductive procedures predicted readmission. Patients with these risk factors or postoperative complications may benefit from closer post-discharge monitoring.

Original languageEnglish (US)
Pages (from-to)165-176
Number of pages12
JournalJournal of Gastrointestinal Surgery
Volume24
Issue number1
DOIs
StatePublished - Jan 1 2020

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Drug Therapy
Colectomy
Ileus
Neoplasms
Databases
Abdominal Abscess
Failure to Thrive
Anastomotic Leak
Total Parenteral Nutrition
Operative Time
Pulmonary Embolism
Venous Thrombosis
Fistula
Morbidity
Infection

Keywords

  • Cytoreductive surgery
  • Hyperthermic intraperitoneal chemotherapy
  • Readmission

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Readmissions After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy : a US HIPEC Collaborative Study. / Lee, Tiffany C.; Wima, Koffi; Sussman, Jeffrey J.; Ahmad, Syed A.; Cloyd, Jordan M.; Ahmed, Ahmed; Fournier, Keith; Lee, Andrew J.; Dineen, Sean; Powers, Benjamin; Veerapong, Jula; Baumgartner, Joel M.; Clarke, Callisia; Mogal, Harveshp; Zaidi, Mohammad Y.; Maithel, Shishir K.; Leiting, Jennifer; Grotz, Travis; Lambert, Laura; Hendrix, Ryan J.; Abbott, Daniel E.; Pokrzywa, Courtney; Blakely, Andrew M.; Lee, Byrne; Johnston, Fabian M.; Greer, Jonathan; Patel, Sameer H.

In: Journal of Gastrointestinal Surgery, Vol. 24, No. 1, 01.01.2020, p. 165-176.

Research output: Contribution to journalArticle

Lee, TC, Wima, K, Sussman, JJ, Ahmad, SA, Cloyd, JM, Ahmed, A, Fournier, K, Lee, AJ, Dineen, S, Powers, B, Veerapong, J, Baumgartner, JM, Clarke, C, Mogal, H, Zaidi, MY, Maithel, SK, Leiting, J, Grotz, T, Lambert, L, Hendrix, RJ, Abbott, DE, Pokrzywa, C, Blakely, AM, Lee, B, Johnston, FM, Greer, J & Patel, SH 2020, 'Readmissions After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: a US HIPEC Collaborative Study', Journal of Gastrointestinal Surgery, vol. 24, no. 1, pp. 165-176. https://doi.org/10.1007/s11605-019-04463-y
Lee, Tiffany C. ; Wima, Koffi ; Sussman, Jeffrey J. ; Ahmad, Syed A. ; Cloyd, Jordan M. ; Ahmed, Ahmed ; Fournier, Keith ; Lee, Andrew J. ; Dineen, Sean ; Powers, Benjamin ; Veerapong, Jula ; Baumgartner, Joel M. ; Clarke, Callisia ; Mogal, Harveshp ; Zaidi, Mohammad Y. ; Maithel, Shishir K. ; Leiting, Jennifer ; Grotz, Travis ; Lambert, Laura ; Hendrix, Ryan J. ; Abbott, Daniel E. ; Pokrzywa, Courtney ; Blakely, Andrew M. ; Lee, Byrne ; Johnston, Fabian M. ; Greer, Jonathan ; Patel, Sameer H. / Readmissions After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy : a US HIPEC Collaborative Study. In: Journal of Gastrointestinal Surgery. 2020 ; Vol. 24, No. 1. pp. 165-176.
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abstract = "Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) results in significant morbidity and readmissions. Previous studies have been limited by single-institution design or lack of tumor details in the database used. Methods: The 12-institution US HIPEC Collaborative Database was queried between 1999 and 2017. Preoperative and intraoperative patient and tumor details were analyzed for associations with readmissions. Results: A total of 2017 of 2372 cases were included in the analysis. The 30-day readmission rate was 15.9{\%} (n = 321). Common indications for readmission included failure to thrive (29.9{\%}), infection (23.6{\%}), and ileus/bowel obstruction (15.1{\%}). The readmitted cohort had more complications, including intra-abdominal abscess (21.2{\%} vs 6.2{\%}), ileus (28.0{\%} vs 17.2{\%}), anastomotic leak (11.2{\%} vs 2.2{\%}), enteric fistula (5.6{\%} vs 1.5{\%}), deep venous thrombosis (6.2{\%} vs 2.5{\%}), and pulmonary embolism (6.9{\%} vs 2.5{\%}). Factors independently associated with readmission (p < 0.05) included ECOG score ≥ 3 (OR 3.4), depression (OR 2.4), total parenteral nutrition (OR 3.6), low anterior resection or partial colectomy (OR 2.0), and stoma creation (OR 2.2). Factors not associated included neoadjuvant chemotherapy, peritoneal cancer index, and completeness of cytoreduction. Readmission rate between 31 and 90 days was 3.9{\%} (n = 78). Independent predictors (p < 0.05) included operative time (OR 1.1), low anterior resection or partial colectomy (OR 1.7), and stoma creation (OR 2.2). Conclusions: In the largest study to date examining readmissions after CRS-HIPEC, 30-day readmission rate was 15.9{\%}. Tumor factors failed to predict readmission, whereas preoperative functional status and depression along with individual cytoreductive procedures predicted readmission. Patients with these risk factors or postoperative complications may benefit from closer post-discharge monitoring.",
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TY - JOUR

T1 - Readmissions After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

T2 - a US HIPEC Collaborative Study

AU - Lee, Tiffany C.

AU - Wima, Koffi

AU - Sussman, Jeffrey J.

AU - Ahmad, Syed A.

AU - Cloyd, Jordan M.

AU - Ahmed, Ahmed

AU - Fournier, Keith

AU - Lee, Andrew J.

AU - Dineen, Sean

AU - Powers, Benjamin

AU - Veerapong, Jula

AU - Baumgartner, Joel M.

AU - Clarke, Callisia

AU - Mogal, Harveshp

AU - Zaidi, Mohammad Y.

AU - Maithel, Shishir K.

AU - Leiting, Jennifer

AU - Grotz, Travis

AU - Lambert, Laura

AU - Hendrix, Ryan J.

AU - Abbott, Daniel E.

AU - Pokrzywa, Courtney

AU - Blakely, Andrew M.

AU - Lee, Byrne

AU - Johnston, Fabian M.

AU - Greer, Jonathan

AU - Patel, Sameer H.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) results in significant morbidity and readmissions. Previous studies have been limited by single-institution design or lack of tumor details in the database used. Methods: The 12-institution US HIPEC Collaborative Database was queried between 1999 and 2017. Preoperative and intraoperative patient and tumor details were analyzed for associations with readmissions. Results: A total of 2017 of 2372 cases were included in the analysis. The 30-day readmission rate was 15.9% (n = 321). Common indications for readmission included failure to thrive (29.9%), infection (23.6%), and ileus/bowel obstruction (15.1%). The readmitted cohort had more complications, including intra-abdominal abscess (21.2% vs 6.2%), ileus (28.0% vs 17.2%), anastomotic leak (11.2% vs 2.2%), enteric fistula (5.6% vs 1.5%), deep venous thrombosis (6.2% vs 2.5%), and pulmonary embolism (6.9% vs 2.5%). Factors independently associated with readmission (p < 0.05) included ECOG score ≥ 3 (OR 3.4), depression (OR 2.4), total parenteral nutrition (OR 3.6), low anterior resection or partial colectomy (OR 2.0), and stoma creation (OR 2.2). Factors not associated included neoadjuvant chemotherapy, peritoneal cancer index, and completeness of cytoreduction. Readmission rate between 31 and 90 days was 3.9% (n = 78). Independent predictors (p < 0.05) included operative time (OR 1.1), low anterior resection or partial colectomy (OR 1.7), and stoma creation (OR 2.2). Conclusions: In the largest study to date examining readmissions after CRS-HIPEC, 30-day readmission rate was 15.9%. Tumor factors failed to predict readmission, whereas preoperative functional status and depression along with individual cytoreductive procedures predicted readmission. Patients with these risk factors or postoperative complications may benefit from closer post-discharge monitoring.

AB - Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) results in significant morbidity and readmissions. Previous studies have been limited by single-institution design or lack of tumor details in the database used. Methods: The 12-institution US HIPEC Collaborative Database was queried between 1999 and 2017. Preoperative and intraoperative patient and tumor details were analyzed for associations with readmissions. Results: A total of 2017 of 2372 cases were included in the analysis. The 30-day readmission rate was 15.9% (n = 321). Common indications for readmission included failure to thrive (29.9%), infection (23.6%), and ileus/bowel obstruction (15.1%). The readmitted cohort had more complications, including intra-abdominal abscess (21.2% vs 6.2%), ileus (28.0% vs 17.2%), anastomotic leak (11.2% vs 2.2%), enteric fistula (5.6% vs 1.5%), deep venous thrombosis (6.2% vs 2.5%), and pulmonary embolism (6.9% vs 2.5%). Factors independently associated with readmission (p < 0.05) included ECOG score ≥ 3 (OR 3.4), depression (OR 2.4), total parenteral nutrition (OR 3.6), low anterior resection or partial colectomy (OR 2.0), and stoma creation (OR 2.2). Factors not associated included neoadjuvant chemotherapy, peritoneal cancer index, and completeness of cytoreduction. Readmission rate between 31 and 90 days was 3.9% (n = 78). Independent predictors (p < 0.05) included operative time (OR 1.1), low anterior resection or partial colectomy (OR 1.7), and stoma creation (OR 2.2). Conclusions: In the largest study to date examining readmissions after CRS-HIPEC, 30-day readmission rate was 15.9%. Tumor factors failed to predict readmission, whereas preoperative functional status and depression along with individual cytoreductive procedures predicted readmission. Patients with these risk factors or postoperative complications may benefit from closer post-discharge monitoring.

KW - Cytoreductive surgery

KW - Hyperthermic intraperitoneal chemotherapy

KW - Readmission

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U2 - 10.1007/s11605-019-04463-y

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JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

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