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Readmissions After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: a US HIPEC Collaborative Study.

Published on Jan 1, 2020in Journal of Gastrointestinal Surgery2.686
· DOI :10.1007/S11605-019-04463-Y
Tiffany C. Lee1
Estimated H-index: 1
(UC: University of Cincinnati),
Koffi Wima14
Estimated H-index: 14
(UC: University of Cincinnati)
+ 24 AuthorsSameer H. Patel14
Estimated H-index: 14
(UC: University of Cincinnati)
Abstract
BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) results in significant morbidity and readmissions. Previous studies have been limited by single-institution design or lack of tumor details in the database used. METHODS: The 12-institution US HIPEC Collaborative Database was queried between 1999 and 2017. Preoperative and intraoperative patient and tumor details were analyzed for associations with readmissions. RESULTS: A total of 2017 of 2372 cases were included in the analysis. The 30-day readmission rate was 15.9% (n = 321). Common indications for readmission included failure to thrive (29.9%), infection (23.6%), and ileus/bowel obstruction (15.1%). The readmitted cohort had more complications, including intra-abdominal abscess (21.2% vs 6.2%), ileus (28.0% vs 17.2%), anastomotic leak (11.2% vs 2.2%), enteric fistula (5.6% vs 1.5%), deep venous thrombosis (6.2% vs 2.5%), and pulmonary embolism (6.9% vs 2.5%). Factors independently associated with readmission (p /= 3 (OR 3.4), depression (OR 2.4), total parenteral nutrition (OR 3.6), low anterior resection or partial colectomy (OR 2.0), and stoma creation (OR 2.2). Factors not associated included neoadjuvant chemotherapy, peritoneal cancer index, and completeness of cytoreduction. Readmission rate between 31 and 90 days was 3.9% (n = 78). Independent predictors (p < 0.05) included operative time (OR 1.1), low anterior resection or partial colectomy (OR 1.7), and stoma creation (OR 2.2). CONCLUSIONS: In the largest study to date examining readmissions after CRS-HIPEC, 30-day readmission rate was 15.9%. Tumor factors failed to predict readmission, whereas preoperative functional status and depression along with individual cytoreductive procedures predicted readmission. Patients with these risk factors or postoperative complications may benefit from closer post-discharge monitoring.
  • References (30)
  • Citations (5)
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References30
Newest
#1Anghela Z. Paredes (The Ohio State University Wexner Medical Center)H-Index: 4
#2Sherif Abdel-Misih (The Ohio State University Wexner Medical Center)H-Index: 9
Last. Jordan M. Cloyd (The Ohio State University Wexner Medical Center)H-Index: 9
view all 6 authors...
2 CitationsSource
#1Yael Dreznik (TAU: Tel Aviv University)H-Index: 3
#2Aviad Hoffman (TAU: Tel Aviv University)H-Index: 5
Last. Mordechai Gutman (TAU: Tel Aviv University)H-Index: 19
view all 9 authors...
2 CitationsSource
#1Johan Gagnière (French Institute of Health and Medical Research)H-Index: 11
#2Julie Veziant (French Institute of Health and Medical Research)H-Index: 4
Last. Karem SlimH-Index: 36
view all 6 authors...
Background Whether cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is safe and worthwhile for elderly patients remains unclear. This meta-analysis of outcomes after CRS plus HIPEC for the elderly aimed to generate a higher level of evidence and precise indications for these patients.
3 CitationsSource
#1Willemien J. van Driel (NKI-AVL: Netherlands Cancer Institute)H-Index: 9
#2Simone N. Koole (NKI-AVL: Netherlands Cancer Institute)H-Index: 1
Last. Gabe S. Sonke (NKI-AVL: Netherlands Cancer Institute)H-Index: 28
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Abstract Background Treatment of newly diagnosed advanced-stage ovarian cancer typically involves cytoreductive surgery and systemic chemotherapy. We conducted a trial to investigate whether the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreductive surgery would improve outcomes among patients who were receiving neoadjuvant chemotherapy for stage III epithelial ovarian cancer. Methods In a multicenter, open-label, phase 3 trial, we randomly assigned 245 patients...
174 CitationsSource
#1Kaitlyn J. Kelly (UCSD: University of California, San Diego)H-Index: 19
#2Luis Cajas (UC: University of California)H-Index: 1
Last. Andrew M. Lowy (UC: University of California)H-Index: 50
view all 4 authors...
Introduction Readmission rates following surgery are subject to scrutiny in efforts to control health care costs. This study was designed to define the 60-day readmission rate following cytoreduction and HIPEC at a high-volume center and to identify factors associated with readmission.
4 CitationsSource
#2Rebecca Slack (University of Texas MD Anderson Cancer Center)H-Index: 27
Last. George J. ChangH-Index: 46
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BACKGROUND:Ileostomies are a routine part of the care of patients with rectal cancer, but are associated with significant risk for dehydration, readmission, and acute kidney injury. Telemedicine has proven beneficial in decreasing readmission in chronic medical illnesses, but its utility in patients
2 CitationsSource
#1Matthew M. Symer (NewYork–Presbyterian Hospital)H-Index: 7
#2Jonathan S. Abelson (NewYork–Presbyterian Hospital)H-Index: 12
Last. Heather Yeo (Cornell University)H-Index: 20
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Introduction Many surgical readmissions are preventable. Mobile health technology can identify nascent complications and potentially prevent readmission.
12 CitationsSource
#1Lawrence LeeH-Index: 1
Last. Lucas SiderisH-Index: 22
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Background and Objectives Morbidity after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) for colorectal peritoneal carcinomatosis (PC) may negatively affect survival. The objective was to determine the impact of postoperative complications (CX) on survival in patients undergoing CRS + HIPEC for colorectal PC. Methods All patients undergoing laparotomy for planned CRS + HIPEC for colorectal PC at a single institution from 1999 to 2014 were included. Patients wer...
8 CitationsSource
#1Chukwuemeka Ihemelandu (Washington Cancer Institute)H-Index: 4
#2Stephen Fernandez (MedStar Health)H-Index: 4
Last. Paul H. Sugarbaker (Washington Cancer Institute)H-Index: 83
view all 3 authors...
Introduction Our aim was to develop a prognostic model for predicting overall survival following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with appendiceal adenocarcinoma and peritoneal metastasis.
3 CitationsSource
Background Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a combined treatment option for well-selected patients with peritoneal carcinomatosis (PC). The study aimed to identify factors influencing cancer-specific survival (CSS) and disease-free survival (DFS).
9 CitationsSource
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Newest
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#1JC Chen (The Ohio State University Wexner Medical Center)
#2Eliza W. Beal (The Ohio State University Wexner Medical Center)H-Index: 10
Last. Jordan M. Cloyd (The Ohio State University Wexner Medical Center)H-Index: 9
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BACKGROUND: Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is indicated for patients with peritoneal dissemination of appendiceal cancer. The role of neoadjuvant chemotherapy (NAC) before CRS-HIPEC remains controversial. METHODS: A retrospective review of adult patients who underwent CRS +/- HIPEC for metastatic appendiceal cancer between 2000-2017 was performed. Patients who received NAC followed by surgery were compared with those who underwent su...
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#1Michael K. Turgeon (Emory University)
#2Adriana C. Gamboa (Emory University)H-Index: 1
Last. Jula Veerapong (UCSD: University of California, San Diego)H-Index: 8
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BACKGROUND: Patient age is a significant factor in preoperative selection for major abdominal surgery. The association of age, tumor biology, and postoperative outcomes in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) remains ill-defined. METHODS: Retrospective analysis was performed for patients who underwent a CCR0/1 CRS/HIPEC from the US HIPEC Collaborative Database (2000-2017). Age was categorized into /= 65 years. Primary outcome was p...
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#1Benjamin Powers (USF: University of South Florida)H-Index: 1
#2Sean P. Dineen (USF: University of South Florida)H-Index: 19
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#1Benjamin D. PowersH-Index: 5
#2Seth FelderH-Index: 1
Last. Vikrom K. Dhar (University of Cincinnati Academic Health Center)H-Index: 6
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BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is offered to select patients with peritoneal metastases. In instances of recurrence/progression, a repeat CRS/HIPEC may be considered. The perioperative morbidity and the potential oncologic benefits are not well described. PATIENTS AND METHODS: We performed a retrospective analysis of a multiinstitutional database to assess the perioperative outcomes following repeat CRS/HIPEC (repeat). Kaplan-Meier and...
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