Pre-Hospital Admission Adversely Affects Outcomes after Colorectal Cancer Surgery: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Database
Kalu R, Tang A, and Stefanou A. Pre-Hospital Admission Adversely Affects Outcomes after Colorectal Cancer Surgery: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Database. Journal of the American College of Surgeons 2020; 231(4):e107.
Journal of the American College of Surgeons
Introduction: Colorectal cancer is the third most common cancer in the US. Multiple factors such as age, sex, stage at diagnosis, tumor biology, invasiveness, and setting of surgery, have been shown to affect colon cancer outcomes even with optimal management. Patients usually undergo elective or emergent surgeries for colon malignancy while a significant proportion are admitted to the hospital beforehand. To our knowledge the effect of pre-hospital admission before colorectal surgery has not be previously reported. Using the National Surgical Quality Improvement Program (NSQIP) targeted colectomy database, we evaluated post-surgical outcomes of this patient population.
Methods: The NSQIP database (2012-2017) was used to identify patients who underwent colon cancer resections and their preoperative admission status. Multivariate logistic regression weighted by inverse propensity score was performed to compare outcomes of the 2 groups.
Results: A total of 9486 patients were evaluated, 50.1% males and 76% Caucasian. Preadmitted patients (12.9%) were significantly older, had multiple comorbidities, and more frequently had open operations. The preadmitted patients had a significantly longer total length of stay (15.9 vs 7.4 days), perioperative bleeding (20.3% vs 12.1%), and wound dehiscence (2.0% vs 1.1%). However, they had lower readmission rates (11.5% vs 14.3%, p<0.05). There was no significant group difference in terms of rates of surgical site infection or reoperation.
Conclusion: Compared to their counterparts preadmitted colorectal patients have a significantly longer LOS, bleeding complication, wound dehiscence, but a lower rate of readmission. Further study is needed to assess for long-term cancer-specific outcomes of these patients.