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Poor Outcomes of Gastric Cancer Surgery After Admission Through the Emergency Department

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA

    Ian Solsky MD, Patricia Friedmann MS, Peter Muscarella MD & Haejin In MD, MPH, MBA

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  1. Ian Solsky MD
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  2. Patricia Friedmann MS
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  3. Peter Muscarella MD
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  4. Haejin In MD, MPH, MBA
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Correspondence to Ian Solsky MD.

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Solsky, I., Friedmann, P., Muscarella, P. et al. Poor Outcomes of Gastric Cancer Surgery After Admission Through the Emergency Department. Ann Surg Oncol 24, 1180–1187 (2017). https://doi.org/10.1245/s10434-016-5696-z

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  • DOI: https://doi.org/10.1245/s10434-016-5696-z

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