(PM P16) The Use of Predictive Modeling for Prolonged Hospital Length of Stay in Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy
Saturday, February 15, 2020
12:35 PM – 12:40 PM
Background: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is used to treat peritoneal surface malignancies of various histopathologic origins. Due to the complexity of CRS/HIPEC, patients experience a longer hospital length of stay (LOS) than typical surgical patients. Predictive modeling was performed to identify factors associated with prolonged LOS to better recognize patients who would benefit from enhanced recovery protocols.
Methods: Primary outcome was prolonged LOS (> median LOS). Multivariable logistic regression was performed and model performance was assessed using k-folds cross-validation. Odds ratios (OR) and 95% confidence intervals (CI) were reported.
Results: There were a total of 479 CRS/HIPECs performed during the study period, in which 366 remained after exclusion criteria. The median (quartiles) LOS for these patients was 10 days (7, 12 days). Multivariable logistic regression revealed a variety of factors associated with increased LOS that were used to construct a risk calculator that demonstrated high PPV and NPV in predicting increased LOS. Additionally, after stratification of patients by the extremes of hospital LOS, younger patient age was found to be correlated with hospital LOS < 7 days while factors indicative of high disease burden were associated with hospital LOS > 12 days.
Conclusions: Factors associated with prolonged LOS following CRS/HIPEC were identified and integrated into a risk calculator that can facilitate post-operative triaging of resources and stratification of risk. Patients of older age or with symptomatic peritoneal metastasis may be considered for more rigorous prehabilitation and enhanced recovery protocols given their increased LOS in the hospital.