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DAYS-AT-HOME AFTER GASTROINTESTINAL CANCER SURGERY: A NOVEL PATIENT-CENTERED OUTCOME MEASURE
Tiago Ribeiro
*1,2, Adom Bondzi-Simpson
1,2, Wing Chan
3, Alyson L. Mahar
4, Angela Jerath
2,5, Natalie Coburn
1,2,5, Julie Hallet
1,2,51Surgery, University of Toronto, Toronto, ON, Canada; 2University of Toronto Institute of Health Policy Management and Evaluation, Toronto, ON, Canada; 3Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; 4Queen's University, Kingston, ON, Canada; 5Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Introduction: Surgery has an important role in the curative treatment of patients with Gastro-intestinal (GI) cancers. With the rising incidence of GI cancers, there is a need for more patient-centered data after surgery in research and to inform clinical discussions. Days-at-home (DAH) after surgery is a novel, validated, patient-centered outcome measure that represents the time patients spend outside of health care institutions. The objective of this work was to evaluate DAH after surgery for GI cancers and explore predictors establishing the groundwork for its future use.
Methods: We conducted a retrospective cohort study using administrative data at ICES in Ontario, Canada. Adults ≥18 years with a diagnosis of non-metastatic GI cancer between 2003 – 2021 were identified. Patients were excluded if there was a second cancer diagnosis within 2 years from cancer diagnosis. DAH over 30 (DAH-30), 90, 180 and 365 days was calculated from the date of index surgery and stratified by cancer site. Calculation of DAH incorporates days spent in hospital, emergency department, rehabilitation centres, inpatient mental health care, and long-term care facilities. An exploratory analysis was performed using multivariable quantile regression to evaluate cancer, treatment and patient factors associated with DAH-90.
Results: A total of 77,061 patients were included in the study cohort. The overall median DAH were as follows: DAH-30=23 days (IQR 18 – 25), DAH-90=82 days (IQR 76 – 85), DAH-180=172 (IQR 164 – 175), and DAH-365=355 (IQR 344 – 359). The distribution was left skewed with a spike at 0 (
Figure). Large variability was observed across GI cancer sites with small bowel tumors having the highest DAH-90=84 (IQR 79 – 86) and esophageal tumors having the lowest DAH-90=76 (IQR 63 – 80). In our exploratory analysis multiple factors were associated with DAH-90. Notably, emergency surgery was associated with a 2.8-day reduction (95%CI 2.6-3.0) in median DAH-90 (p<0.001) and open surgical approach was associated with a 2.4-day reduction (95%CI 2.3-2.4) in median DAH-90 (p<0.001).
Conclusions: In patients undergoing GI cancer surgery, DAH varies across cancer site, procedure type, and important treatment and patient characteristics. To ensure patient-centered research, future work on GI cancer surgery should consider the use of this novel measure in addition to traditional peri-operative endpoints.
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