• 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 Hendrix, Daniel E Abbott, Courtney Pokrzywa, Andrew M Blakely, Byrne Lee, Fabian M Johnston, Jonathan Greer, and Sameer H Patel.
• Cincinnati Research on Outcomes and Safety in Surgery (CROSS), Division of Surgical Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
• J. Gastrointest. Surg. 2020 Jan 1; 24 (1): 165-176.

BackgroundCytoreductive 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.MethodsThe 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.ResultsA 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).ConclusionsIn 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.

27 keywords...

hide…