Journal of Gastrointestinal Surgery

, Volume 22, Issue 5, pp 913–920 | Cite as

Factors Associated with Emergency Department Utilization and Admission in Patients with Colorectal Cancer

  • Tiffany K. Weidner
  • John T. Kidwell
  • David A. Etzioni
  • Lindsey R. Sangaralingham
  • Holly K. Van Houten
  • Dennis Asante
  • Molly Moore Jeffery
  • Nilay Shah
  • Nabil WasifEmail author
Original Article



We assessed emergency department (ED) utilization in patients with colorectal cancer to identify factors associated with ED visits and subsequent admission, as well as identify a high-risk subset of patients that could be targeted to reduce ED visits.


Data from Optum Labs Data Warehouse, a national administrative claims database, was retrospectively analyzed to identify patients with colorectal cancer from 2008 to 2014. Multivariable logistic regression was used to identify factors associated with ED visits and ED “super-users” (3+ visits). Repeated measures analysis was used to model ED visits resulting in hospitalization as a logistic regression based on treatments 30 days prior to ED visit.


Of 13,466 patients with colorectal cancer, 7440 (55.2%) had at least one ED visit within 12 months of diagnosis. Factors associated with having an ED visit included non-white race, advancing age, increased comorbidities, and receipt of chemotherapy or radiation. 69.2% of patients who visited the ED were admitted to the hospital. A group of 1834 “super-users” comprised 13.6% of our population yet accounted for 52.1% of the total number of ED visits and 32.3% of admissions.


Over half of privately insured patients undergoing treatment for colorectal cancer will visit the ED within 12 months of diagnosis. Within this group, we identify common factors for a high-risk subset of patients with three or more ED visits who account for over half of all ED visits and a third of all admissions. These patients could potentially be targeted with alternative management strategies in the outpatient setting.


Colorectal cancer Emergency department Emergency room Readmission 


Authors’ Contribution

All authors meet all of the criteria for the definition of authorship: substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


This publication was made possible by funding from the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

Supplementary material

11605_2018_3707_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 14.7 kb)
11605_2018_3707_MOESM2_ESM.docx (14 kb)
ESM 2 (DOCX 13.9 kb)
11605_2018_3707_MOESM3_ESM.docx (14 kb)
ESM 3 (DOCX 14.0 kb)


  1. 1.
    Hussain, T., et al., Fragmentation in specialist care and stage III colon cancer. Cancer, 2015. 121(18): p. 3316–24.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Skolarus, T.A., Y. Zhang, and B.K. Hollenbeck, Understanding fragmentation of prostate cancer survivorship care: implications for cost and quality. Cancer, 2012. 118(11): p. 2837–45.CrossRefPubMedGoogle Scholar
  3. 3.
    Graboyes, E.M., et al., Postoperative care fragmentation and thirty-day unplanned readmissions after head and neck cancer surgery. Laryngoscope, 2017. 127(4): p. 868–874.CrossRefPubMedGoogle Scholar
  4. 4.
    Herzog, T., et al., Complicated sigmoid diverticulitis—Hartmann’s procedure or primary anastomosis? Acta Chir Belg, 2011. 111(6): p. 378–83.CrossRefPubMedGoogle Scholar
  5. 5.
    Jelinek, G.A., et al., Caught in the middle: tensions around the emergency department care of people with advanced cancer. Emerg Med Australas, 2013. 25(2): p. 154–60.CrossRefPubMedGoogle Scholar
  6. 6.
    Ahn, S., et al., Emergency department cancer unit and management of oncologic emergencies: experience in Asan Medical Center. Support Care Cancer, 2012. 20(9): p. 2205–10.CrossRefPubMedGoogle Scholar
  7. 7.
    Wallace, P.J., et al., Optum Labs: building a novel node in the learning health care system. Health affairs, 2014. 33(7): p. 1187–94.CrossRefPubMedGoogle Scholar
  8. 8.
    Levack, M.M., et al., Sigmoidectomy syndrome? Patients’ perspectives on the functional outcomes following surgery for diverticulitis. Dis Colon Rectum, 2012. 55(1): p. 10–7.CrossRefPubMedGoogle Scholar
  9. 9.
    McClish, D.K., et al., Ability of Medicare claims data and cancer registries to identify cancer cases and treatment. Am J Epidemiol, 1997. 145(3): p. 227–33.CrossRefPubMedGoogle Scholar
  10. 10.
    Deyo, R.A., D.C. Cherkin, and M.A. Ciol, Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol, 1992. 45(6): p. 613–9.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Costi, R., et al., Challenging a classic myth: pneumoperitoneum associated with acute diverticulitis is not an indication for open or laparoscopic emergency surgery in hemodynamically stable patients. A 10-year experience with a nonoperative treatment. Surg Endosc, 2012. 26(7): p. 2061–71.CrossRefPubMedGoogle Scholar
  12. 12.
    Tang, N., et al., Trends and characteristics of US emergency department visits, 1997-2007. JAMA, 2010. 304(6): p. 664–70.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Barbera, L., C. Taylor, and D. Dudgeon, Why do patients with cancer visit the emergency department near the end of life? CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2010. 182(6): p. 563–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Henson, L.A., et al., Emergency department attendance by patients with cancer in their last month of life: a systematic review and meta-analysis. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015. 33(4): p. 370–6.CrossRefGoogle Scholar
  15. 15.
    Wang, S.M., et al., Effects of multidisciplinary team care on utilization of emergency care for patients with lung cancer. The American journal of managed care, 2014. 20(8): p. e353–64.PubMedGoogle Scholar
  16. 16.
    Alkema, G.E., et al., Reduced mortality: the unexpected impact of a telephone-based care management intervention for older adults in managed care. Health services research, 2007. 42(4): p. 1632–50.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Seow, H., et al., Does Increasing Home Care Nursing Reduce Emergency Department Visits at the End of Life? A Population-Based Cohort Study of Cancer Decedents. Journal of pain and symptom management, 2015. 51(2): p. 204–12.Google Scholar
  18. 18.
    Mayer, D.K., et al., Why do patients with cancer visit emergency departments? Results of a 2008 population study in North Carolina. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2011. 29(19): p. 2683–8.CrossRefGoogle Scholar
  19. 19.
    Burke, T.A., T. Wisniewski, and F.R. Ernst, Resource utilization and costs associated with chemotherapy-induced nausea and vomiting (CINV) following highly or moderately emetogenic chemotherapy administered in the US outpatient hospital setting. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2011. 19(1): p. 131–40.CrossRefGoogle Scholar
  20. 20.
    Benson, A.B., 3rd, et al., Metastatic colon cancer, version 3.2013: featured updates to the NCCN Guidelines. J Natl Compr Canc Netw, 2013. 11(2): p. 141–52; quiz 152.CrossRefPubMedGoogle Scholar
  21. 21.
    Benson, A.B., 3rd, et al., Colon Cancer, Version 1.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2017. 15(3): p. 370–398.CrossRefPubMedGoogle Scholar
  22. 22.
    Benson, A.B., 3rd, et al., Rectal Cancer, Version 2.2015. J Natl Compr Canc Netw, 2015. 13(6): p. 719–28; quiz 728.CrossRefPubMedGoogle Scholar
  23. 23.
    Ma, B., et al., What has preoperative radio(chemo)therapy brought to localized rectal cancer patients in terms of perioperative and long-term outcomes over the past decades? A systematic review and meta-analysis based on 41,121 patients. Int J Cancer, 2017. 141(5): p. 1052–1065.CrossRefPubMedGoogle Scholar
  24. 24.
    Hong, R., B.M. Baumann, and E.D. Boudreaux, The emergency department for routine healthcare: race/ethnicity, socioeconomic status, and perceptual factors. J Emerg Med, 2007. 32(2): p. 149–58.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Tiffany K. Weidner
    • 1
  • John T. Kidwell
    • 1
  • David A. Etzioni
    • 2
    • 3
  • Lindsey R. Sangaralingham
    • 2
  • Holly K. Van Houten
    • 2
  • Dennis Asante
    • 2
  • Molly Moore Jeffery
    • 2
  • Nilay Shah
    • 2
    • 4
  • Nabil Wasif
    • 1
    • 2
    Email author
  1. 1.Department of General SurgeryMayo ClinicPhoenixUSA
  2. 2.Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterUSA
  3. 3.Division of Colorectal SurgeryMayo ClinicPhoenixUSA
  4. 4.OptumLabsCambridgeUSA

Personalised recommendations