Hospital utilization and disposition among patients with malignant bowel obstruction: a population-based comparison of surgical to medical management

Abstract

BackgroundMalignant bowel obstruction (MBO) is often a terminal event in end-stage cancer patients. The decision to intervene surgically is complex, given the risk of harm in patients with a limited lifespan. Therefore, we sought to compare clinically meaningful outcomes in MBO patients treated with surgical versus medical management using population-based data.MethodsWe performed a retrospective analysis of hospitalized patients with MBO from 2006 to 2010 using the California Office of Statewide Health Planning and Development dataset. Hospital-free days (HFDs) at 30-, 90-, and 180-days were calculated accounting for all hospitalization, emergency department visit, and skilled nursing facility lengths of stay. Adjusted regression models were used to compare HFDs, disposition, complications, in-hospital death, and survival for surgical versus medical MBO cohorts, using inverse probability of treatment weighting with propensity scores.ResultsOf 4576 MBO patients, 3421 (74.8%) were treated medically and 1155 (25.2%) were treated surgically. Surgical patients had higher rates of complications (44.0% vs. 21.3%, p < 0.0001) and in-hospital death (9.5% vs. 3.9%, p < 0.0001) with lower rates of disposition to home (76.3% vs. 89.8%, p < 0.0001). Surgical patients had fewer 30- and 90-day HFDs compared to medical patients (p < 0.01). However, at 180-days, there were no differences in HFDs between treatment groups. There was no difference in overall survival between surgical and medical patients (median 6.5 vs. 6.4 months).ConclusionIn this population-based analysis, medical management was associated with less hospital utilization at 30- and 90-days, fewer in-hospital deaths, and more frequent discharges to home. These data underscore the potential benefits of medical management for MBO patients at the end-of-life.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-5108-9) contains supplementary material, which is available to authorized users.

Strategies to Promote ResiliencY (SPRY): a randomised embedded multifactorial adaptative platform (REMAP) clinical trial protocol to study interventions to improve recovery after surgery in high-risk patients

“…The primary endpoint of SPRY Core Protocol hospitalfree days (HFD) is up to 90 days. [33][34][35][36] This composite endpoint is an ordered categorical variable defined as the number of days from the day of surgery to the 90 thereafter, during which the patient is alive and free of hospitalisation and was chosen for three reasons. First, this composite variable quantifies the care required for patients with reduced physiological reserve with an increased risk of both specific postoperative complications (ie, wound infections) and overall progression of frailty (ie, progressive sarcopenia resulting in a fall and hip fracture) resulting in fewer HFD.…”

Conventional health care service utilization among cancer survivors that visit traditional and complementary providers in the Tromsø study: a cross-sectional study

“…Following active treatment, cancer survivors have healthcare surveillance needs related to cancer [ 13 – 15 ], cancer treatment [ 13 , 16 ], and other medical [ 17 ] and psychological comorbidities [ 18 , 19 ]. Post-treatment follow-up is provided by GPs, oncologists, and other specialists, [ 18 , 20 ] as well as rehabilitation providers such as physiotherapists and chiropractors [ 21 ].…”

Management of Cancer-Associated Intestinal Obstruction in the Final Year of Life

“…Similarly, a systematic review by Paul Olson et al 7 suggests that while surgery was able to palliate obstructive symptoms for many patients, serious complications (7-44%) and mortality (6-32%) were commonly encountered. Recently, Bateni et al 18 demonstrated higher rates of hospital complications (44% vs 21%) and in-hospital death (10% vs 4%) and lower rates of discharge to home (76% vs 90%) in patients treated with surgery compared to medical management.…”