Mo1742 COLONIC STENT PLACEMENT IS ASSOCIATED WITH LOWER RISK OF IN-HOSPITAL DEATH AND NEED FOR SURGERY AMONG PATIENTS ADMITTED WITH MALIGNANT LARGE BOWEL OBSTRUCTION: AN ANALYSIS OF A LARGE NATIONAL SAMPLE

Abstract

Prior studies have demonstrated efficacy of stent placement for palliation or as a bridge to surgery in small cohorts of patients with malignant colonic obstruction. Our aim is to evaluate the effect of stent placement on in-hospital mortality and need for surgery in a large nationally representative sample of patients admitted with malignant colonic obstruction. National Inpatient Sample (NIS) data from 2002 to 2014 were used. NIS is a nationally representative sample of all elective and non-elective hospital inpatient stays. Patients who were admitted non-electively with diagnoses of colorectal cancer and intestinal obstruction were included in this study. Colonic stent placement was ascertained using ICD-9 procedure codes. The main outcomes of the study were death or need for surgery during the admission, length of stay, and total cost of admission. Exploratory analyses were performed in patients with right and left colon cancers separately. Analysis was performed after matching patients who did or did not receive stent for age, gender, presence and severity of comorbidites using Elixhauser comorbidity index, and location of colon cancer and presence of metastatic cancer. Separate multivariable regressions were used to evaluate the effect of these covariates on outcomes as appropriate. 654,197 patients were admitted with a diagnosis of colon cancer, out of which 41,790 were admitted non-electively with a diagnosis of bowel obstruction and were included in the analysis (Table 1). 1,153 patients underwent colonic stenting for an overall rate of 2.76%. There was a significant secular trend for increased rate of stent placement over the study period (p<0.001). Colonic stenting was associated with a 3.5% lower risk of death during admission (p=0.001) in matched analysis. Similarly, colonic stenting was associated with a significant 29% lower chance of need for surgery during the same admission (p<0.001). Colonic stenting was not associated with a significant change in the length of admission but was associated with increased cost (Table 2). Separate analysis showed significant association between stenting and lower risk of death and surgery in patients with cancer of left colon, however the trend for lower risk of death in patients with cancer of right colon did not reach statistical significance (Table 2). Amongst patients who underwent surgery, stenting before surgery was associated with a 10% decrease in the risk of creating a stoma (p=0.026). Stenting was associated with a significant decrease in the risk of creating a stoma among patients with cancer of left colon, but not right colon. In patients who were admitted non-electively with malignant colon obstruction, stenting was associated with lower risk of death and need for surgery during admission, as well as lower rate of stoma creation during inpatient surgery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)