title: Poor Outcomes of Gastric Cancer Surgery After Admission Through the Emergency Department.
abstract: BACKGROUND
  Outcomes after nonelective surgery for gastric cancer (GC) are poorly defined. Our objective was to compare outcomes of patients undergoing nonelective GC surgery after admission through the emergency department (EDSx) with patients receiving elective surgery or surgery after planned admission (non-EDSx) nationally.
  
  
  METHODS
  The Nationwide Inpatient Sample (NIS) database was used to examine patients undergoing GC surgery between 2008 and 2012. Demographics and outcomes were compared between EDSx and non-EDSx. Multivariable logistic regression was used to examine predictors of discharge to home.
  
  
  RESULTS
  Of 9279 patients, 1143 (12%) underwent EDSx. They were more likely to be female (42 vs. 35%), nonwhite (56 vs. 33%), aged ≥75 years (40 vs. 26%), in the lowest quartile for household income (31 vs. 25%), have one or more comorbidities (87 vs. 70%), treated at a nonteaching hospital (46 vs. 25%), and have a concomitant diagnosis of obstruction, perforation, or bleeding (30 vs. 6%). They had longer total length of stay (LOS; 16 vs. 9 days), longer median postoperative stays (10 vs. 9 days), higher in-hospital mortality (8 vs. 3%), and were less likely to be discharged home (63 vs. 82%). EDSx was more expensive ($125,300 vs. $83,604). EDSx was associated with a lower likelihood of discharge to home (odds ratio 0.52, 95% CI 0.43-0.62).
  
  
  CONCLUSIONS
  Nationally, 12% of GC surgeries are performed after emergency department admission, which occurs more frequently in vulnerable populations and results in worse outcomes. Understanding factors leading to increased EDSx and developing strategies to decrease EDSx may improve GC surgery outcomes.
authors.affiliation: Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA. isolsky@montefiore.org.
authors.forename: Ian
authors.initials: I
authors.lastname: Solsky
authors.affiliation: Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Friedmann
authors.affiliation: Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Muscarella
authors.affiliation: Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Haejin
authors.initials: H
authors.lastname: In
mesh_terms: D000368:Aged; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006276:Health Facility Size; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data*; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*; D015996:Survival Rate; D014481:United States