• Boateng Kubi, Jonathan Gunn, Nadege Fackche, Jordan M Cloyd, Sherif Abdel-Misih, Travis Grotz, Jennifer Leiting, Keith Fournier, Andrew J Lee, Sean Dineen, Sophie Dessureault, Jula Veerapong, Joel M Baumgartner, Callisia Clarke, Harveshp Mogal, Sameer H Patel, Vikrom Dhar, Laura Lambert, Ryan J Hendrix, Daniel E Abbott, Courtney Pokrzywa, Mustafa Raoof, Byrne Lee, Shishir K Maithel, Charles A Staley, Fabian M Johnston, Nae-Yuh Wang, and Jonathan B Greer.
• Department of Surgery, Johns Hopkins University, Baltimore, Maryland.
• J. Surg. Res. 2020 Nov 1; 255: 475-485.

BackgroundUsing 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.MethodsPatients 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.ResultsThe 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).ConclusionsEarly 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.Copyright © 2020 Elsevier Inc. All rights reserved.

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