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Pancreatic Cancer Surgery Following Emergency Department Admission: Understanding Poor Outcomes and Disparities in Care

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The impact of emergency department admission prior to pancreatic resection on perioperative outcomes is not well described. We compared patients who underwent pancreatic cancer surgery following admission through the emergency department (ED-surgery) with patients receiving elective pancreatic cancer surgery (elective) and outcomes.

Study Design

The Nationwide Inpatient Sample database was used to identify patients undergoing pancreatectomy for cancer over 5 years (2008–2012). Demographics and hospital characteristics were assessed, along with perioperative outcomes and disposition status.

Results

A total of 8158 patients were identified, of which 516 (6.3%) underwent surgery after admission through the ED. ED-surgery patients were more often socioeconomically disadvantaged (non-White 39% vs. 18%, Medicaid or uninsured 24% vs. 7%, from lowest income area 33% vs. 21%; all p < .0001), had higher comorbidity (Elixhauser score > 6: 44% vs. 26%, p < .0001), and often had pancreatectomy performed at sites with lower annual case volume (< 7 resections/year: 53% vs. 24%, p < .0001). ED-surgery patients were less likely to be discharged home after surgery (70% vs. 82%, p < .0001) and had higher mortality (7.4% vs. 3.5%, p < .0001). On multivariate analysis, ED-surgery was independently associated with a lower likelihood of being discharged home (aOR 0.55 (95%CI 0.43–0.70)).

Conclusion

Patients undergoing pancreatectomy following ED admission experience worse outcomes compared with those who undergo surgery after elective admission. The excess of socioeconomically disadvantaged patients in this group suggests factors other than clinical considerations alone drive this decision. This study demonstrates the need to consider presenting patient circumstances and preoperative oncologic coordination to reduce disparities and improve outcomes for pancreatic cancer surgery.

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Funding

The authors received financial support with database acquisition and statistical analysis software from the National Cancer Institute of the National Institutes for Health and the Montefiore Medical Center Department of Surgery. Effort by HI was supported by the National Cancer Institute of the National Institutes of Health under the award number 2K12 CA132783-06 (Paul Calabresi Career Development Award for Clinical Oncology).

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Authors and Affiliations

  1. Department of Surgery, Montefiore Medical Center, Bronx, NY, USA

    Vishes V. Mehta, Patricia Friedmann, John C. McAuliffe, Peter Muscarella II & Haejin In

  2. Department of Surgery, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Block Building #112, Bronx, NY, 10461, USA

    Vishes V. Mehta, Patricia Friedmann, John C. McAuliffe, Peter Muscarella II & Haejin In

  3. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Haejin In

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  1. Vishes V. Mehta
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Contributions

Study conception and design: Mehta and In

Acquisition of data: Mehta, Friedmann, and In

Analysis and interpretation of data: Mehta, Friedmann, and In

Drafting of manuscript: Mehta and In

Critical revision: Mehta, McAuliffe, Muscarella, and In

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Correspondence to Haejin In.

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The authors declare that they have no conflict of interest.

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Synopsis

Patients who undergo pancreatectomy after an ED admission represent a socioeconomic and clinically disadvantaged population. Method of presentation is an important indicator of cancer patients at risk for poor outcomes.

Presentation

American College of Surgeons 102nd Clinical Congress. 10/19/2016, Washington, DC

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Mehta, V.V., Friedmann, P., McAuliffe, J.C. et al. Pancreatic Cancer Surgery Following Emergency Department Admission: Understanding Poor Outcomes and Disparities in Care. J Gastrointest Surg 25, 1261–1270 (2021). https://doi.org/10.1007/s11605-020-04614-6

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