PM8 - Failure to Thrive Following CRS-HIPEC: Causes and Consequences

Introduction: Failure to thrive (FTT) describes a complex syndrome of nutritional failure, functional decline, and loss of independence in adults. Readmission following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is often a harbinger of functional decline and poor oncologic outcomes. Rates of FTT following CRS-HIPEC are unknown. This study aimed to determine underlying causes, risk factors, and prognostic significance of FTT for following CRS-HIPEC.

Methods: We reviewed all patients who underwent CRS-HIPEC from 2010 to 2018. All readmissions within 90 days of discharge were examined. FTT was determined by ICD codes and chart review. We compared baseline characteristics, oncologic data, perioperative outcomes, and survival among three patient groups: FTT readmission, non-FTT readmission, no readmission.

Results: 1,068 discharges were identified. 379 patients (36%) were readmitted, of which 134 (35%) were labeled as FTT. Nutritional failure (n=70, 52%) and infection (n=44, 33%) were the primary co-diagnoses for FTT. Patients with FTT were older, had a higher proportion of colorectal primaries and worse peri-operative functional status. They had higher PCI with more complex resections, longer hospital stays, and more complications (all p<0.05). Stoma creation (OR 4.0, p<0.001), VTE in hospital (OR 2.4, p=0.01), and age >50 (OR 2.1, p=0.002) were the strongest predictors for FTT. FTT readmission was associated with worse median OS compared to non-FTT readmission or no readmission on both univariate (30 mos vs 48 mos and 80 mos respectively, p<0.001) and multivariate analysis (HR 1.4, p=0.04).

Conclusions: FTT is a common occurrence following CRS-HIPEC which adversely affects both quality and quantity of life, and appears to be associated with baseline functional status and extent of cytoreduction. Peri-operative strategies for improving nutrition and activity in this high-risk cohort along with early intervention in FTT may improve both surgical outcomes and overall survival.