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Can the Risk of Non-home Discharge After Resection of Gastric Adenocarcinoma Be Predicted: a Seven-Institution Study of the US Gastric Cancer Collaborative

  • 2014 SSAT Poster Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

There are no validated methods to preoperatively identify patients with increased risk of discharge to skilled nursing facilities following resection of gastric cancer. We sought to identify preoperative predictors of non-home discharge to optimize transition of care to skilled nursing facility.

Methods

Patients who underwent resection of gastric cancer from 2000 to 2012 from seven participating institutions of the US Gastric Cancer Collaborative were analyzed. Fisher’s exact tests, Student t tests, and logistic regression analyses identified preoperative variables associated with non-home discharge. A prediction tool was created and validated through c-indices. Survival analysis was conducted according to the methods of Kaplan and Meier.

Results

Out of the 918 patients identified, 93 (10 %) were discharged to nonhome location. Univariate analysis identified advancing age, American Society of Anesthesiology (ASA) score, hypertension, decreasing preoperative albumin, and lack of neoadjuvant chemotherapy as risk factors for non-home discharge (NHD). Multivariable analysis identified advanced age (odds ratio (OR) = 1.07, 95 % confidence interval (CI) = 1.04–1.10, p < 0.0001), depressed preoperative albumin (OR = 2.17, 95 % CI = 1.47–3.19, p = 0.0001), and total gastrectomy (OR = 2.56, 95 % CI = 1.53–4.3, p = 0.0003) as risk factors for NHD. The c-index of the model and the validation population were 0.76 and 0.8, respectively. Additionally, there was an association of decreased overall survival in patients discharged to nonhome location (35.5 months, home discharge, vs 12 months, NHD, p < 0.0001).

Conclusions

Older patients with compromised nutritional status have greater risk of NHD following resection of gastric cancer. The prediction tool can augment preoperative planning to optimize transition of care to skilled nursing facility.

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Authors and Affiliations

  1. University of Wisconsin-Madison, Madison, WI, USA

    Alexandra W. Acher, Emily Winslow, Clifford S. Cho, Ken Meredith, Glen Leverson & Sharon M. Weber

  2. Emory University, Atlanta, GA, USA

    Malcolm H. Squires, David A. Kooby & Shishir K. Maithel

  3. Washington University School of Medicine, Washington, DC, USA

    Ryan C. Fields & Linda X. Jin

  4. Stanford University, Stanford, CA, USA

    George A. Poultsides & David Worhunsky

  5. Wake Forest University, Winston-Salem, NC, USA

    Konstantinos I. Votanopoulos & Edward A. Levine

  6. The Johns Hopkins University, Baltimore, MD, USA

    Timothy M. Pawlik & Aslam Ejaz

  7. Ohio State University, Columbus, OH, USA

    Carl Schmidt, Mark Bloomston & Neil Saunders

  8. Department of General Surgery, University of Wisconsin School of Medicine and Public Health, H4/730, 7375 Clinical Science Center, 600 Highland Ave, Madison, WI, 53792, USA

    Sharon M. Weber

Authors
  1. Alexandra W. Acher
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  2. Malcolm H. Squires
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  4. George A. Poultsides
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  6. Konstantinos I. Votanopoulos
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  8. Linda X. Jin
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  9. Aslam Ejaz
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  10. David A. Kooby
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  11. Mark Bloomston
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  12. David Worhunsky
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  13. Edward A. Levine
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  14. Neil Saunders
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  15. Emily Winslow
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  16. Clifford S. Cho
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  17. Ken Meredith
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  18. Glen Leverson
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  19. Shishir K. Maithel
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  20. Sharon M. Weber
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Correspondence to Sharon M. Weber.

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Acher, A.W., Squires, M.H., Fields, R.C. et al. Can the Risk of Non-home Discharge After Resection of Gastric Adenocarcinoma Be Predicted: a Seven-Institution Study of the US Gastric Cancer Collaborative. J Gastrointest Surg 19, 207–216 (2015). https://doi.org/10.1007/s11605-014-2690-2

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  • DOI: https://doi.org/10.1007/s11605-014-2690-2

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