Factors associated with 30-day readmission and long-term efficacy of enteral stent placement for malignancy.
BACKGROUND
Readmissions to the hospital within 30 days of discharge (30-day readmission rate) may impact stent use in palliative treatment of cancer.


OBJECTIVE
Our objective was to investigate the incidence of readmission and factors predicting readmissions and long-term outcomes in patients with self-expanding metal stents (SEMS) placed for malignant obstruction.


METHODS
Retrospective analysis of all patients who underwent placement of SEMS from 2007 to 2012 for malignant esophageal, gastroduodenal, and colonic obstruction. Incidence and variables associated with 30-day readmission and long-term outcomes were determined.


RESULTS
A total of 191 patients underwent stent placement. The 30-day readmission rate was 17.3 % (N = 33). Readmissions were for stent-related complications in 7.3 % (N = 14) and non-stent-related complications in 9.9 % (N = 19). Stent placement was technically successful in 185 of 191 (96.9 %) and clinically successful in 170 of 191 (89.0 %) patients. On long-term follow-up, 32 (16.8 %) patients needed re-intervention. The mean stent patency was 142 days. Readmission within 30 days was independently associated with development of early complications (<7 days) following stent placement (odds ratio [OR] 5.90; 95 % confidence interval [CI] 2.04–17.1), while the stent location did not impact readmission risk. On Cox regression analysis, American Society of Anesthesiologists physical classification (OR 1.36; 95 % CI 1.02–1.87) and stent location in the esophagus (OR 1.82; 95 % CI 1.10–3.02) were independently associated with long-term mortality.


CONCLUSIONS
Early complications following stent placement increase the risk of 30-day readmission. SEMS is efficacious long-term for palliation of malignant gastrointestinal obstruction.
Udayakumar
U
Navaneethan
Sudhir
S
Duvuru
Ramprasad
R
Jegadeesan
Preethi G K
PG
Venkatesh
Norma G
NG
Gutierrez
Jeffrey
J
Hammel
Ravi P
RP
Kiran
Madhusudhan R
MR
Sanaka
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000150:complications* / Q000601:surgery; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D010166:Palliative Care / Q000379:methods*; D010359:Patient Readmission / Q000639:trends*; D011379:Prognosis; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors