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Readmissions After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: a US HIPEC Collaborative Study

  • 2019 SSAT Quick Shot Presentation
  • Published:
Journal of Gastrointestinal Surgery

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.

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Author information

Authors and Affiliations

  1. Cincinnati Research on Outcomes and Safety in Surgery (CROSS), Division of Surgical Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Tiffany C. Lee, Koffi Wima, Jeffrey J. Sussman, Syed A. Ahmad & Sameer H. Patel

  2. Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Jordan M. Cloyd & Ahmed Ahmed

  3. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Keith Fournier & Andrew J. Lee

  4. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL, USA

    Sean Dineen & Benjamin Powers

  5. Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA, USA

    Jula Veerapong & Joel M. Baumgartner

  6. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Callisia Clarke & Harveshp Mogal

  7. Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Mohammad Y. Zaidi & Shishir K. Maithel

  8. Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA

    Jennifer Leiting & Travis Grotz

  9. Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA

    Laura Lambert & Ryan J. Hendrix

  10. Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA

    Daniel E. Abbott & Courtney Pokrzywa

  11. Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA

    Andrew M. Blakely & Byrne Lee

  12. Department of Surgery, Johns Hopkins University, Baltimore, MD, USA

    Fabian M. Johnston & Jonathan Greer

  13. Section of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way (ML 0558), Cincinnati, OH, 45267-0558, USA

    Sameer H. Patel

Authors
  1. Tiffany C. Lee
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  2. Koffi Wima
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  3. Jeffrey J. Sussman
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  6. Ahmed Ahmed
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  19. Laura Lambert
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Contributions

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

Corresponding author

Correspondence to Sameer H. Patel.

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Lee, T.C., Wima, K., Sussman, J.J. et al. Readmissions After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: a US HIPEC Collaborative Study. J Gastrointest Surg 24, 165–176 (2020). https://doi.org/10.1007/s11605-019-04463-y

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