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.
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.
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|
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
Legal entity responsible for the study
Has not received any funding.
All authors have declared no conflicts of interest.