National trends in discharge disposition after hepatic resection for malignancy.
BACKGROUND
There is a paucity of data on the trends in discharge disposition for patients undergoing hepatic resection for malignancy.


OBJECTIVE
To analyse the national trends in discharge disposition after hepatic resection for malignancy.


METHODS
The National Inpatient Sample (NIS) database was queried (1993 to 2005) to identify patients that underwent hepatic resection for malignancy and analyse the discharge status (home, home health or rehabilitation/skilled facility).


RESULTS
A weighted total of 74,520 patients underwent hepatic resection of whom, 53,770 patients had a principal diagnosis of malignancy. The overall mortality improved from 6.3% to 3.4%. After excluding patients that died in the post-operative period and those with incomplete discharge status, 45,583 patients were included. The proportion of patients that had acute care needs preventing them from being discharged home without assistance increased from 10.9% in 1993 to 19.5% in 2005. While there was an increase in the number of patients discharged to home health care during this time (8.9% to 13.8%), there was a larger increase in the proportion of patients that were discharged to a rehabilitation or skilled nursing facility (2% to 5.7%). Despite a decrease in the mortality rates, there was no improvement in rate of patients discharged home without assistance over the period of the study.


CONCLUSIONS
The results of the present study demonstrate that after hepatic resection, a significant proportion of patients will need assistance upon discharge. This information needs to be included in patient counselling during pre-operative risk and benefit assessment.
Division of Surgical Oncology, Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198-3280, USA.
Bhavin C
BC
Shah
Fred
F
Ullrich
Lynette
L
Smith
Premila
P
Leiphrakpam
Quan
Q
Ly
Aaron
A
Sasson
Chandrakanth
C
Are
D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006699:Home Care Services / Q000639:trends; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000534:rehabilitation* / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D010351:Patient Discharge / Q000639:trends*; D012047:Rehabilitation Centers / Q000639:trends; D018570:Risk Assessment; D012307:Risk Factors; D012866:Skilled Nursing Facilities / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
Acta Chir Belg. 2009 May-Jun;109(3):340-4
19943590
Ann Surg. 1999 Mar;229(3):322-30
10077043
J Clin Oncol. 2007 Oct 10;25(29):4575-80
17925551
Dig Surg. 2008;25(6):421-9
19212114
J Am Coll Surg. 2005 Jun;200(6):845-53
15922194
Chin Med J (Engl). 2009 Oct 5;122(19):2268-77
20079125
Arch Surg. 2009 Feb;144(2):143-7; discussion 148
19221325
HPB (Oxford). 2009 Sep;11(6):510-5
19816616
Ann Surg. 2009 Nov;250(5):831-41
19801936
Eur J Surg Oncol. 2008 Jun;34(6):609-14
17764887
J Am Coll Surg. 2004 Jul;199(1):31-8
15217626
Med Care. 1998 Jan;36(1):8-27
9431328
Br J Surg. 2010 Mar;97(3):366-76
20101645
Gut. 2010 Mar;59(3):387-96
20207642
Arch Surg. 2003 Nov;138(11):1198-206; discussion 1206
14609867
Ann Oncol. 2004 Mar;15(3):460-6
14998849
Ann Surg. 2009 Sep;250(3):440-8
19730175
J Am Coll Surg. 2007 Jun;204(6):1284-92
17544086
Arch Surg. 2003 Feb;138(2):185-91
12578418
J Clin Oncol. 2009 Aug 1;27(22):3677-83
19470929
J Gastrointest Surg. 2003 Dec;7(8):1034-44
14675713
Ann Surg. 2002 Oct;236(4):397-406; discussion 406-7
12368667
Am Surg. 2000 Apr;66(4):412-5; discussion 415-6
10776881
Ann Surg. 2009 May;249(5):799-805
19387322