Potentially Avoidable Admissions and Prolonged Hospitalization in Patients with Suspected Colon Cancer.

Autor: Tagerman DL; Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA., Ramos-Santillan V; Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.; Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA., Kalam A; Albert Einstein College of Medicine, Bronx, NY, USA., Wang F; Albert Einstein College of Medicine, Bronx, NY, USA., Schriner JB; Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA., Arientyl V; Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA., Solsky I; Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.; Department of Surgical Oncology, Wake Forest University, Winston-Salem, NC, USA., Friedmann P; Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA., Abdelnaby A; Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA., In H; Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA. hi80@cinj.rutgers.edu.; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA. hi80@cinj.rutgers.edu.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2023 Aug; Vol. 30 (8), pp. 4748-4758. Date of Electronic Publication: 2023 May 17.
DOI: 10.1245/s10434-023-13593-2
Abstrakt: Background: Suspicion of cancer in the Emergency Department (ED) may lead to potentially avoidable and prolonged admissions. We aimed to examine the reasons for potentially avoidable and prolonged hospitalizations after admissions from the ED for new colon cancer diagnoses (ED-dx).
Methods: A retrospective, single-institution analysis was conducted of patients with ED-dx between 2017 and 2018. Defined criteria were used to identify potentially avoidable admissions. Patients without avoidable admissions were examined for ideal length of stay (iLOS), using separate defined criteria. Prolonged length of stay (pLOS) was defined as actual length of stay (aLOS) being greater than 1 day longer than iLOS.
Results: Of 97 patients with ED-dx, 12% had potentially avoidable admissions, most often (58%) for cancer workup. Very little difference in demographic, tumor characteristics, or symptoms were found, except patients with potentially avoidable admissions were more functional (Eastern Cooperative Oncology Group [ECOG] score 0-1: 83% vs. 46%; p = 0.049) and had longer symptom duration prior to ED presentation {24 days (interquartile range [IQR] 7-75) vs. 7 days (IQR 2-21)}. Among the 60 patients who had necessary admissions but did not require urgent intervention, 78% had pLOS, most often for non-urgent surgery (60%) and further oncologic workup. The median difference between iLOS and aLOS was 12 days (IQR 8-16) for pLOS.
Conclusions: Potentially avoidable admissions following Ed-dx were uncommon but were mostly for oncologic workup. Once admitted, the majority of patients had pLOS, most often for definitive surgery and further oncologic workup. This suggests a lack of systems to safely transition to outpatient cancer management.
(© 2023. Society of Surgical Oncology.)
Databáze: MEDLINE
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