SSAT - Can the Risk of Non-Home Discharge After Resection of Gastric Adenocarcinoma Be Predicted?

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Can the Risk of Non-Home Discharge After Resection of Gastric Adenocarcinoma Be Predicted?
Alexandra W. Acher^*¹, Shishir K. Maithel², Ryan Fields⁴, George a. Poultsides³, Carl Schmidt⁷, Konstantinos I. Votanopoulos⁶, Timothy M. Pawlik⁵, Linda X. Jin⁴, David C. Linehan⁴, William G. Hawkins⁴, Steven M. Strasberg⁴, Aslam Ejaz⁵, Malcolm H. Squires², David Kooby², David Worhunsky³, Edward a. Levine⁶, Neil D. Saunders⁷, Gaya Spolverato⁵, Emily Winslow¹, Clifford S. Cho¹, Ken Meredith¹, Glen Leverson¹, Sharon M. Weber¹
¹Surgery, University of Wisconsin Hospital and Clinics, Madison, WI; ²Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA; ³Stanford University Medical Center, Stanford, CA; ⁴Washington University in St. Louise, St. Louise, MO; ⁵Johns Hopkins University School of Medicine, Baltimore, MD; ⁶Wake Forest University, Winston-Salem, NC; ⁷The Ohio State University Comprehensive Cancer Center - The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH

BACKGROUND: Currently, there are no validated methods to preoperatively identify patients with an increased risk of discharge to skilled nursing facilities (SNFs; non-home discharge) following resection of gastric cancer (GC). In these circumstances, length of stay is often prolonged while arrangements are completed. Utilizing a multi-institutional database of patients who underwent surgery for GC, we sought to identify preoperative predictors of non-home discharge in an effort to anticipate and optimize transitions of care to SNFs.
METHODS: Patients who underwent resection of GC from 2000-2012 from the 7 participating institutions of the U.S. Gastric Cancer Collaborative were analyzed. In-hospital deaths following resection were excluded. Logistic regression and Fischer's exact test were used to identify preoperative factors predictive of non-home discharge.
RESULTS: 923 patients were identified. Of these, 93 (10%) were discharged to a location other than home (SNF). Univariate analysis identified the following preoperative variables as significant risk factors for non-home discharge: age, ASA score, hypertension, diabetes, albumin, creatinine, bleeding, weight loss, and neoadjuvant chemotherapy. On multivariate analysis, advanced age (OR = 1.07, 95% CI = 1.04-1.09, p < 0.0001) and depressed pre-operative serum albumin (OR= 0.45, 95% CI = 0.30-0.67, p = 0.0001) were independently associated with non-home discharge. Patients 70 yrs or older with a preoperative albumin </= 3.4 had the highest risk of non-home discharge (21.7% discharged to non-home location versus 4.2% in patients under 70 yrs with a preoperative albumin > 3.4 g/dL; see Table).
CONCLUSIONS: Older patients with compromised nutritional status are at increased risk for non-home discharge following resection of gastric cancer. In these patients, preoperative planning for transition to skilled nursing facilities may reduce demand on hospital resources as well as ease the burden of transition of care for patients and hospital care teams.

Table: Odds of non-home discharge (NHD) in high-risk versus low risk populations

	Age >/= 70 & Albumin < / = 3.4g/dL	Age < 70 & Albumin > 3.4g/dL	OR	95% CI	p-value
% NHD (n)	21.7% (25)	4.2% (15)	6.33	3.2-12.5	< 0.0001

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