Outcomes of in-hospital cardiopulmonary resuscitation (ICPR) for cardiac arrest in adult patients with metastatic solid cancers: A nationwide inpatient sample (NIS) database analysis from 2012 to 2014.

Abstract

44 Background: Cardiopulmonary arrest is known to have a poor prognosis which is further worsened by existing co-morbidities. The prevalence of metastatic malignancy is rapidly increasing with improved cancer treatments and yet the outcomes of ICPR are not well studied in these patients. We aim to study the epidemiology, associations and outcomes in this subpopulation. Methods: Retrospective cohort analysis of the 2012 to 2014 NIS database. We included patients ≥ 18 years with the International Classification of Diseases, 9th Revision, Clinical Modification procedure codes for ICPR and diagnosis codes for solid metastatic cancers. Primary diagnosis of cardiopulmonary arrest was excluded (represents out‐of‐hospital arrest.) Primary outcome was inpatient mortality following ICPR and the factors associated were analyzed using logistic regression. Results: Amongst 1,432,240 admissions of adults with metastatic solid cancers, 0.6% (n = 8840) received ICPR, of which 82% (n = 7245) died in the same admission. Inpatient mortality following ICPR in adults without metastatic solid cancers was 68.7%. For adults with metastatic solid cancers receiving ICPR, mean age was 65.9 years, 57.7% were males and 60.6% Caucasian. Also, 11.5% of them had an inpatient palliative care encounter. On multivariate logistic regression analysis, African Americans had higher mortality than Caucasians (OR 1.5, p 0.01) while elective admission and age < 50 years had lower mortality (OR 0.5, p < 0.05 and OR 0.5, p 0.01 respectively.) There was no difference in mortality based on site of primary tumor, gender, day of admission, Charlson Comorbidity Index, insurance status and hospital teaching status, location or size. Conclusions: Amongst adult patients with metastatic solid cancers receiving ICPR, 82% died within the same admission. Race, age and admission type predicted mortality. Despite known poor prognosis, only 11.5% had a palliative care encounter. [Table: see text]