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Trends in Discharge Disposition Following Hepatectomy for Hepatocellular Carcinoma Among Medicare Beneficiaries

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Post-acute care (PAC) services can include home healthcare, long-term care hospitals, and skilled nursing facilities. We sought to define factors associated with PAC discharge disposition among Medicare beneficiaries who underwent hepatectomy for hepatocellular carcinoma (HCC).

Methods

Data for Medicare beneficiaries with a diagnosis of HCC and who underwent a hepatectomy between 2004 and 2015 were retrieved from the SEER-Medicare database. Discharge disposition was defined as routine (HSC: discharged to home) or non-routine (SNF/ICF, discharged to skilled nursing/intermediate care facilities, or HHA, discharge to home with home health agency). The Cochran-Mantel-Haenszel test and multivariable logistic regression were used to assess trends in discharge disposition.

Results

Among 1305 patients, the median patient age at diagnosis was 72 years (IQR: 68–76). Approximately 4 in 5 patients were discharged to HSC (77.4%; n = 1010). The odds of a non-routine discharge decreased by 7.0% annually from 2004 to 2015 (ORtrend, 0.93; 95%CI, 0.89–0.97; ptrend = 0.001). Several factors were associated with non-routine discharge, including patient age (OR 1.06, 95%CI 1.04–1.09) and longer LOS (OR 1.07, 95%CI 1.05–1.10). In contrast, patients who had a minor hepatectomy (OR 0.69, 95%CI 0.52–0.93) at a teaching hospital (OR 0.63, 95%CI 0.45–0.89) had lower odds of a non-routine discharge (all P < 0.05). HSC discharge increased over time (2004–2007 (n = 205, 68.1%) vs. 2008–2011 (n = 330, 77.8%) vs. 2012–2015 (n = 475, 81.9%); ptrend < 0.001). Over the same time period, there was a decreasing trend in 90-day readmission (2004–2007 (n = 91, 30.2%) vs. 2008–2011 (n = 107, 25.2%) vs. 2012–2015 (n = 129, 22.2%); ptrend = 0.03).

Conclusion

Utilization of PAC services following hepatic resection of HCC decreased by 57.0% between 2004 and 2015. These data highlight that decreased PAC utilization was not generally associated with higher readmission rates following resection of HCC.

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Authors and Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA

    Djhenne M. Dalmacy MS, J. Madison Hyer MS, Adrian Diaz MD, Alessandro Paro MD, Diamantis I. Tsilimigras MD & Timothy M Pawlik MD, MPH, MTS, PhD

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  1. Djhenne M. Dalmacy MS
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  2. J. Madison Hyer MS
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  3. Adrian Diaz MD
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  4. Alessandro Paro MD
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  5. Diamantis I. Tsilimigras MD
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  6. Timothy M Pawlik MD, MPH, MTS, PhD
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Contributions

DMD, JMH, AD, and TMP conceived of and designed this work. DMD and JMH performed data analysis. DMD and JMH drafted the manuscript. JMH, AD, AP, DMD, DIT, and TMP critically revised the manuscript, provided approval of the final version, and agreed to be accountable for all aspects of the work.

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Correspondence to Timothy M Pawlik MD, MPH, MTS, PhD.

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Dalmacy, D.M., Hyer, J.M., Diaz, A. et al. Trends in Discharge Disposition Following Hepatectomy for Hepatocellular Carcinoma Among Medicare Beneficiaries. J Gastrointest Surg 25, 2842–2850 (2021). https://doi.org/10.1007/s11605-021-05000-6

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  • DOI: https://doi.org/10.1007/s11605-021-05000-6

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