Factors Associated with 30-day Readmission and Long-term Efficacy of Enteral Stent Placement for Malignancy

Abstract

Background: Quality measures such as readmissions to the hospital within 30 days of discharge (30-day readmission rate) may impact the use of stents in palliative treatment in cancer. Objective: To investigate the incidence of readmission and factors predicting readmissions and long-term outcomes in patients with self-expanding metal stents (SEMS) placed for malignant obstruction. Methods: Retrospective analysis of all patients who were admitted to our center for SEMS from Jan 2007 to Jan 2012 for malignant esophageal, gastroduodenal and colonic obstruction. Incidence and variables associated with 30-day readmission and long-term outcomes were determined. Results: One-hundred ninety-one patients underwent stent placement. The 30-day readmission rate was 17.3% (N=33). Stent-related complications were responsible in 7.3% (N=14) and non stent-related complications responsible for 9.9% (N=19) readmissions. Stent placement was technically successful in 185 of 191 (96.9%) and clinically successful with relief of obstruction combined with a functioning stent after 1 week in 170/191 (89.0%) patients. On long-term follow-up, 32 (16.8%) patients needed reintervention, 22 required repeat endoscopic interventions while the remaining 10 required surgery. The mean stent patency was 142 days; 83.2% of patients had a patent stent until death. Readmission within 30 days was independently associated with development of early complications (<7 days) following stent placement (odds ratio [OR] 5.90; 95% confidence interval [CI] 2.04-17.1), while the stent location did not impact readmission risk. 148 patients (77.5%) were deceased at the end of the study. The overall median survival was 107 days: 89.7 days after esophageal, 107 days after gastroduodenal, and 162.6 days after colonic stenting (Figure 1). On Cox regression analysis, ASA physical classification (OR 1.36; 95% CI 1.02-1.87) and stent location in the esophagus (OR 1.82; 95% CI 1.10-3.02) were independently associated with long-term mortality, while 30-day readmission did not impact the long-term outcomes.FigureConclusion: Early complications following stent placement increase the risk of 30-day readmissions. SEMS is efficacious in the long-term for the palliation of malignant GI obstruction.