Risk factors for in-hospital mortality and prolonged length of stay in older patients with solid tumor malignancies

Shayne, Michelle; Culakova, Eva; Poniewierski, Marek S.; Dale, David C.; Crawford, Jeffrey; Wogu, Adane F.; Lyman, Gary H.

doi:10.1016/j.jgo.2013.05.005

Cited by 26 publications

(24 citation statements)

References 37 publications

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“…Although the toxicities that we detected were those that required intervention or merited a medical diagnosis, we did not detect milder toxicities that did not rise to medical attention, and we were unable to account for important subjective outcomes such as discomfort or quality of life . Second, there may be unmeasured confounders such as comorbid illness or functional status for which we were unable to adjust . Third, we lacked information regarding the actual dose of radiotherapy and the fields used.…”

Section: Discussionmentioning

confidence: 87%

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Comparative effectiveness of surgery and radiosurgery for stage I non–small cell lung cancer

Soulos

Cramer³

et al. 2015

Cancer

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Background Although surgery is the standard treatment for early stage non-small cell lung cancer (NSCLC), stereotactic body radiotherapy (SBRT) has disseminated as an alternative therapy. The comparative mortality and toxicity of these treatments for patients of different life expectancies (LE) are unknown. Methods Using the Surveillance, Epidemiology, and End Results–Medicare linked database, we identified patients age ≥67 who underwent SBRT or surgery for stage I NSCLC from 2007–2009. Matched patients were stratified into short (<5 years) and long (≥5 years) LE. Mortality and complication rates were compared using Poisson regression. Findings Overall, 367 SBRT and 711 surgery patients were matched. Acute toxicity (0–1-month) from SBRT was lower than surgery (7.9% vs. 54.9%, p<.001). At 24-months post-treatment, there was no difference (69.7% vs. 73.9%, p=.31). The incidence rate ratio (IRR) for toxicity for SBRT vs. surgery was 0.74 [95%CI 0.64–0.87]. Overall mortality was lower for SBRT than surgery at 3-months (2.2% vs. 6.1%; p=.005), but by 24-months, overall mortality was higher for SBRT (40.1% vs. 22.3% p<.001). For patients with short LE there was no difference in lung cancer mortality (IRR 1.01 [95% CI 0.40–2.56]). However for patients with long LE, there was greater overall mortality (IRR 1.49 [95% CI 1.11–2.01]) and a trend towards greater lung cancer mortality (IRR 1.63 [95% CI 0.95–2.79]) for SBRT vs. surgery. Conclusions SBRT was associated with lower immediate mortality and toxicity compared to surgery. However, for patients with long LE, there appears to be a relative benefit for surgery compared to SBRT.

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Section: Discussionmentioning

confidence: 87%

“…18 Second, there may be unmeasured confounders such as comorbid illness or functional status for which we were unable to adjust. 19 Third, we lacked information regarding the actual dose of radiotherapy and the fields used. Fourth, it is unclear whether 24 months is sufficient to capture all toxicities from treatment.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of surgery and radiosurgery for stage I non–small cell lung cancer

Soulos

Cramer³

et al. 2015

Cancer

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“…It is a unique opportunity whereby hospitalists, serving as the primary inpatient physician for these patients, can encourage critical analysis of health and stimulate conversations about care. Hospitalization is a time of intense scrutiny and can reveal previously unknown medical, social, cultural, psychological, and spiritual concerns that often declare themselves in acute illness …”

Section: Hospitalization Of the Patient With Advanced Cancer And Rolementioning

confidence: 99%

“…Every year in the United States, approximately 4.7 million cancer‐related hospitalizations and 1.2 million hospital discharges with cancer as the principal diagnosis occur . Limited evidence suggests that hospitalization of the cancer patient is associated with increased morbidity and mortality; average length of survival of patients with advanced cancer after unplanned hospitalization is 3 to 5 months . Furthermore, hospitalization of the cancer patient presents unique challenges in goals of care discussions and patient preferences.…”

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confidence: 99%

Hospitalists caring for patients with advanced cancer: An experience‐based guide

Koo

Tonorezos

Kumar

et al. 2015

Journal of Hospital Medicine

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Every year, nearly five million adults with cancer are hospitalized. Limited evidence suggests that hospitalization of the cancer patient is associated with adverse morbidity and mortality. Hospitalization of the patient with advanced cancer allows for an intense examination of health status in the face of terminal illness and an opportunity for defining goals of care. This experience-based guide reports what is currently known about the topic and outlines a systematic approach to maximizing opportunities, improving quality, and enhancing the well-being of the hospitalized patient with advanced cancer.

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“…The duration of hospitalization may re ect the severity of diseases, complications rates, and medical costs. Furthermore, studies in geriatric and general populations indicate that prolonged hospitalization is associated with increased functional dependence, infection, and comorbidities [18][19][20].…”

Section: Spot Sign Surgery and Length Of Hospital Staymentioning

confidence: 99%

Early Spot Sign is Associated with Functional Outcomes in Primary Intracerebral Hemorrhage Survivors

Hsiao

Tseng

Wang

et al. 2020

Preprint

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Background The computed tomography angiography (CTA) spot sign is a validated predictor of hematoma expansion and 30-day mortality in intracerebral hemorrhage (ICH). However, whether the spot sign predicts worse functional outcomes among ICH survivors remains unclear. This study investigated the frequency of the spot sign and its association with functional outcomes and length of hospital stay among ICH survivors.Methods This was a retrospective analysis of consecutive patients with primary ICH who received CTA within 24 h from presentation to admission to the emergency department of a single medical center between January 2007 and December 2017. Patients who died before discharge and those referred from other hospitals were excluded. CTAs with motion artifacts were excluded from the analysis. The presence of a spot sign was examined by an experienced neuroradiologist. Functional outcomes were determined based on the modified Rankin Scale (mRS) score and Barthel Index (BI). Severe dependency in activities of daily living (ADL) was defined as BI of ≤60 and severe disability as an mRS score of ≥4. Odds ratio (OR) and multiple linear regression were used as measures of association.Results In total, 66 patients met the inclusion criteria, of whom 9 (13.64%) were positive for a spot sign. No significant differences were observed in baseline characteristics between patients with and without a spot sign. Patients with a spot sign tended to be severely dependent in ADL at discharge (66.67% vs 41.07%; OR = 2.87; p = 0.15) and were more likely to require ICH-related surgery (66.67% vs 24.56%; OR = 6.14; p = 0.01). In multiple linear regression, patients with a higher spot sign score had a significantly longer hospital stay (coefficient = 9.57; 95% CI = 2.11–17.03; p = 0.013).Conclusions The presence of a spot sign is a common finding and is associated with longer hospital stay and possibly worse functional outcomes in ICH survivors.

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Risk factors for in-hospital mortality and prolonged length of stay in older patients with solid tumor malignancies

Cited by 26 publications

References 37 publications

Comparative effectiveness of surgery and radiosurgery for stage I non–small cell lung cancer

Comparative effectiveness of surgery and radiosurgery for stage I non–small cell lung cancer

Hospitalists caring for patients with advanced cancer: An experience‐based guide

Early Spot Sign is Associated with Functional Outcomes in Primary Intracerebral Hemorrhage Survivors

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