title: Increased Rates of Prolonged Length of Stay, Readmissions, and Discharge to Care Facilities among Postoperative Patients with Disseminated Malignancy: Implications for Clinical Practice.
abstract: BACKGROUND
  The impact of surgery on end of life care for patients with disseminated malignancy (DMa) is incompletely characterized. The purpose of this study was to evaluate postoperative outcomes impacting quality of care among DMa patients, specifically prolonged length of hospital stay, readmission, and disposition.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for years 2011-2012. DMa patients were matched to non-DMa patients with comparable clinical characteristics and operation types. Primary hepatic operations were excluded, leaving a final cohort of 17,972 DMa patients. The primary outcomes were analyzed using multivariate Cox regression models.
  
  
  RESULTS
  DMa patients represented 2.1% of all ACS-NSQIP procedures during the study period. The most frequent operations were bowel resections (25.3%). Compared to non-DMa matched controls, DMa patients had higher rates of postoperative overall morbidity (24.4% vs. 18.7%, p<0.001), serious morbidity (14.9% vs. 12.0%, p<0.001), mortality (7.6% vs. 2.5%, p<0.001), prolonged length of stay (32.2% vs. 19.8%, p<0.001), readmission (15.7% vs. 9.6%, p<0.001), and discharges to facilities (16.2% vs. 12.9%, p<0.001). Subgroup analyses of patients by procedure type showed similar results. Importantly, DMa patients who did not experience any postoperative complication experienced significantly higher rates of prolonged length of stay (23.0% vs. 11.8%, p<0.001), readmissions (10.0% vs. 5.2%, p<0.001), discharges to a facility (13.2% vs. 9.5%, p<0.001), and 30-day mortality (4.7% vs. 0.8%, p<0.001) compared to matched non-DMa patients.
  
  
  CONCLUSIONS
  Surgical interventions among DMa patients are associated with poorer postoperative outcomes including greater postoperative complications, prolonged length of hospital stay, readmissions, disposition to facilities, and death compared to non-DMa patients. These data reinforce the importance of clarifying goals of care for DMa patients, especially when acute changes in health status potentially requiring surgery occur.
authors: Division of Surgical Oncology, Department of Surgery, University of California, Davis Medical Center, Sacramento, California, United States of America.
authors: Sarah B
authors: SB
authors: Bateni
authors: Hematology/Oncology, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, California, United States of America.
authors: Frederick J
authors: FJ
authors: Meyers
authors: Division of Surgical Oncology, Department of Surgery, University of California, Davis Medical Center, Sacramento, California, United States of America.
authors: Richard J
authors: RJ
authors: Bold
authors: Division of Surgical Oncology, Department of Surgery, University of California, Davis Medical Center, Sacramento, California, United States of America.
authors: Robert J
authors: RJ
authors: Canter
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D016017:Odds Ratio; D010351:Patient Discharge; D010359:Patient Readmission; D011184:Postoperative Period; D016016:Proportional Hazards Models; D015996:Survival Rate; D016896:Treatment Outcome