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ePoster Display

1481P - Predictors for 30-day readmission in patients with pancreatic cancer who had DNR code status

Date

16 Sep 2021

Session

ePoster Display

Presenters

Jasmeet Kaur

Citation

Annals of Oncology (2021) 32 (suppl_5): S1084-S1095. 10.1016/annonc/annonc709

Authors

J. Kaur1, T. Mir2, P. Singh3, S.B. Yadlapalli4, J. Goodman4

Author affiliations

  • 1 Internal Medicine, Saint Joseph Mercy Oakland Hospital, 48341 - PONTIAC/US
  • 2 Internal Medicine, Wayne State, Detroit Medical Center, 48202 - Detroit/US
  • 3 Hematology And Oncology, Barbara Karmanos Cancer Institute, 48201 - Detroit/US
  • 4 Hematology And Oncology, Saint Joseph Mercy Oakland Hospital, 48341 - PONTIAC/US
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Abstract 1481P

Background

Pancreatic cancer is a lethal malignancy, and most patients present with advanced disease. There is little known about the 30-day readmission rate in patients with Do-not resuscitate (DNR) code status in pancreatic cancer.

Methods

This retrospective study of a nationally representative cohort of hospitalized pancreatic cancer patients. The database was obtained from the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP) national readmission (NRD) dataset files between 2016 – 2018. The study aims to look for predictors of mortality and 30-day readmission among patients with pancreatic cancer who had DNR code status. We evaluated readmission in pancreatic cancer with DNR code status in multivariable linear regression models.

Results

There were 240,107 index hospitalizations with pancreatic cancer (PAC) for the years 2016-2018. There were 51,451 (21.4%) PAC patients who had DNR code status during the index hospitalization. Patients with DNR status had a mean age of 68. The PAC patients with DNR status had significantly higher numbers of inpatient mortality (22% (DNR status) vs 3 % (full code) (OR 4.24 (95% CI 3.9-4.6; P <0.001), higher rate of cardiac arrhythmia (26% vs. 19%; p<0.001). The adjusted odd’s ratio (Table) to look for significant readmission predictors for DNR status in PAC included chronic heart failure (OR 1.24, p <0.001), renal failure (OR 1.27, p<.001), and liver disease (OR 2.13, p <0.001). Most patients were treated in urban teaching hospitals, and Medicare was the primary payor in 70.4. Table: 1481P

The adjusted odds ratio of a pancreatic cancer patient has DNR status

Outcomes Adjusted OR (95% CI) p-valve
Heart failure Absent present reference 1.24 (1.13-1.35) <0.001
Cardiac arrhythmia Absent Present - 1.39 (1.31-1.48) <0.001
Hypertension Absent Present - 0.78 (0.73-0.83) <0.001
Renal failure Absent Present - 1.27 (1.14-1.41) <0.001
Liver disease Absent Present - 2.13 (1.98-2.29) <0.001
Diabetes Absent Present - 0.97 (0.92-1.02) 0.22
Alcohol abuse Absent Present - 0.88 (0.77-1.00) 0.06
Obesity Absent Present - 0.87 (0.78-0.97) 0.01
Service payer Medicare Medicaid Private Self-pay - 1.28 (1.14-1.43) 1.38 (1.26-1.51) 2.0 (1.80-2.41) <0.001 <0.001 <0.001

Conclusions

This large nationwide study observed higher inpatient mortality and readmission rates in pancreatic cancer who have DNR code status utilizing hospital resources and healthcare costs. This suggests that patients with advanced pancreas cancer who adopt DNR status be offered early hospice care to avoid inpatient mortality. There is a need to look for data based on racial and ethnic differences.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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