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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. Hendrix
  • Daniel E. Abbott
  • Courtney Pokrzywa
  • Andrew M. Blakely
  • Byrne Lee
  • Fabian M. Johnston
  • Jonathan Greer
  • Sameer H. PatelEmail author
2019 SSAT Quick Shot Presentation

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.

Keywords

Hyperthermic intraperitoneal chemotherapy Cytoreductive surgery Readmission 

Notes

Authors’ Contribution

All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript and approving the final version of the manuscript. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication before its appearance in the Journal of Gastrointestinal Surgery.

Tiffany C. Lee: Conception and design of study, acquisition of data, analysis and interpretation of data, drafting of manuscript, revision and final approval of manuscript

Koffi Wima: Analysis and interpretation of data, revision, and final approval of manuscript

Jeffrey J. Sussman, Syed A. Ahmad, Jordan M. Cloyd, Ahmed Ahmed, Keith Fournier, Andrew Lee, Sean Dineen, Benjamin Powers, Jula Veerapong, Joel M. Baumgartner, Callisia Clarke, Harveshp Mogal, Charles A. Staley, Shishir K. Maithel, Jennifer Leiting, Travis Grotz, Laura Lambert, Ryan J. Hendrix, Sharon M. Weber, Courtney Pokrzywa, Andrew M. Blakely, Byrne Lee, Fabian M. Johnston, Jonathan Greer, Sameer H. Patel: Conception and design of study, acquisition of data, analysis and interpretation, revision, and final approval of manuscript

Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Tiffany C. Lee
    • 1
  • Koffi Wima
    • 1
  • Jeffrey J. Sussman
    • 1
  • Syed A. Ahmad
    • 1
  • Jordan M. Cloyd
    • 2
  • Ahmed Ahmed
    • 2
  • Keith Fournier
    • 3
  • Andrew J. Lee
    • 3
  • Sean Dineen
    • 4
  • Benjamin Powers
    • 4
  • Jula Veerapong
    • 5
  • Joel M. Baumgartner
    • 5
  • Callisia Clarke
    • 6
  • Harveshp Mogal
    • 6
  • Mohammad Y. Zaidi
    • 7
  • Shishir K. Maithel
    • 7
  • Jennifer Leiting
    • 8
  • Travis Grotz
    • 8
  • Laura Lambert
    • 9
  • Ryan J. Hendrix
    • 9
  • Daniel E. Abbott
    • 10
  • Courtney Pokrzywa
    • 10
  • Andrew M. Blakely
    • 11
  • Byrne Lee
    • 11
  • Fabian M. Johnston
    • 12
  • Jonathan Greer
    • 12
  • Sameer H. Patel
    • 1
    • 13
    Email author
  1. 1.Cincinnati Research on Outcomes and Safety in Surgery (CROSS), Division of Surgical OncologyUniversity of Cincinnati College of MedicineCincinnatiUSA
  2. 2.Division of Surgical Oncology, Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusUSA
  3. 3.Department of Surgical OncologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic SciencesMorsani College of MedicineTampaUSA
  5. 5.Division of Surgical Oncology, Department of SurgeryUniversity of CaliforniaSan DiegoUSA
  6. 6.Division of Surgical Oncology, Department of SurgeryMedical College of WisconsinMilwaukeeUSA
  7. 7.Division of Surgical Oncology, Winship Cancer InstituteEmory UniversityAtlantaUSA
  8. 8.Division of Hepatobiliary and Pancreas SurgeryMayo ClinicRochesterUSA
  9. 9.Division of Surgical Oncology, Department of SurgeryUniversity of Massachusetts Medical SchoolWorcesterUSA
  10. 10.Division of Surgical Oncology, Department of SurgeryUniversity of WisconsinMadisonUSA
  11. 11.Division of Surgical Oncology, Department of SurgeryCity of Hope National Medical CenterDuarteUSA
  12. 12.Department of SurgeryJohns Hopkins UniversityBaltimoreUSA
  13. 13.Section of Surgical Oncology, Department of SurgeryUniversity of Cincinnati College of MedicineCincinnatiUSA

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