Can the risk of non-home discharge after resection of gastric adenocarcinoma be predicted: a seven-institution study of the US Gastric Cancer Collaborative.
BACKGROUND
There are no validated methods to preoperatively identify patients with increased risk of discharge to skilled nursing facilities following resection of gastric cancer. We sought to identify preoperative predictors of non-home discharge to optimize transition of care to skilled nursing facility.


METHODS
Patients who underwent resection of gastric cancer from 2000 to 2012 from seven participating institutions of the US Gastric Cancer Collaborative were analyzed. Fisher's exact tests, Student t tests, and logistic regression analyses identified preoperative variables associated with non-home discharge. A prediction tool was created and validated through c-indices. Survival analysis was conducted according to the methods of Kaplan and Meier.


RESULTS
Out of the 918 patients identified, 93 (10 %) were discharged to nonhome location. Univariate analysis identified advancing age, American Society of Anesthesiology (ASA) score, hypertension, decreasing preoperative albumin, and lack of neoadjuvant chemotherapy as risk factors for non-home discharge (NHD). Multivariable analysis identified advanced age (odds ratio (OR) = 1.07, 95 % confidence interval (CI) = 1.04-1.10, p < 0.0001), depressed preoperative albumin (OR = 2.17, 95 % CI = 1.47-3.19, p = 0.0001), and total gastrectomy (OR = 2.56, 95 % CI = 1.53-4.3, p = 0.0003) as risk factors for NHD. The c-index of the model and the validation population were 0.76 and 0.8, respectively. Additionally, there was an association of decreased overall survival in patients discharged to nonhome location (35.5 months, home discharge, vs 12 months, NHD, p < 0.0001).


CONCLUSIONS
Older patients with compromised nutritional status have greater risk of NHD following resection of gastric cancer. The prediction tool can augment preoperative planning to optimize transition of care to skilled nursing facility.
University of Wisconsin-Madison, Madison, WI, USA.
Alexandra W
AW
Acher
Malcolm H
MH
Squires
Ryan C
RC
Fields
George A
GA
Poultsides
Carl
C
Schmidt
Konstantinos I
KI
Votanopoulos
Timothy M
TM
Pawlik
Linda X
LX
Jin
Aslam
A
Ejaz
David A
DA
Kooby
Mark
M
Bloomston
David
D
Worhunsky
Edward A
EA
Levine
Neil
N
Saunders
Emily
E
Winslow
Clifford S
CS
Cho
Ken
K
Meredith
Glen
G
Leverson
Shishir K
SK
Maithel
Sharon M
SM
Weber
D000230:Adenocarcinoma / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D012866:Skilled Nursing Facilities; D013274:Stomach Neoplasms / Q000601:surgery*; D015996:Survival Rate; D014481:United States
D012709:Serum Albumin