FACTORS ASSOCIATED WITH EMERGENCY DEPARTMENT UTILIZATION IN PATIENTS WITH PANCREATIC CANCER
Rida Ahmad*, Krisha Amin, Martin J. Heslin, Annabelle L. Fonseca
Surgery, University of South Alabama, Mobile, AL
Introduction: High Emergency Department (ED) utilization increases the burden on healthcare expenditure. Pancreatic cancer patients are particularly susceptible to increased ED utilization due to disease-related deconditioning, cancer-related complications and treatment side-effects. In this study we aim to identify factors associated with ED utilization after diagnosis of pancreatic cancer.
Methods: We performed a retrospective chart review of patients with pancreatic cancer, using data from a single institution, from October 2017 to August 2022. Primary outcome was all cause ED visits. Univariate logistic regression and chi-square test values are reported for factors associated with ED visits.
Results: 235 patients with pancreatic cancer were identified, of whom 74 % (n=174) were White and 22.1% (n=52) were Black. 54% (n=128) were male, and 25.2% (n=59) had private insurance. Median age at diagnosis was 67.4 years (range 29-89 years). 100 patients (43%) had metastatic disease at initial presentation. 36.32% (n=85) had at least 1 ED visit after their initial diagnosis and 21%(n=50) returned multiple times. There were 200 ED visits overall, of which 138 resulted in inpatient admission. Mean length of stay after hospital readmission was 6.58 days (median 5 days, range:1-37 days). Race was significantly associated with return to ED (χ2=28.25 p<0.001), with Black or African American (63.5%) and multi-racial (80%) patients returning to ED more frequently than White patients (27.2%). Additionally, older age (χ2=17.73. p=0.007), residence in areas of high Area Deprivation Index (ADI) (χ2=14.70 p<0.001) and presence of ≥2 comorbidities (χ2=5.55 p=0.019) was associated with ED visits. Insurance status (p=0.744), gender (p=0.339) and disease stage at presentation (p=0.153) were not associated with return to ED in our patient population.
Conclusion: Sociodemographic variables are associated with increased ED utilization in pancreatic cancer care, and contribute to increased health care costs. Racial minority patients as well as patients residing in regions with high ADI are more likely to have increased ED utilization, indicating a lack of access to health care. Further studies are needed to assess intervention strategies to improve access and optimize delivery of care in patients with pancreatic cancer.
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