Risk factors for in-hospital mortality and prolonged length of stay in older patients with solid tumors

Abstract

9550 Background: Little is known about risk factors that contribute to prolonged hospitalization and mortality in older patients with cancer. Methods: Cancer patients ≥65 years of age hospitalized between 1995 and 2003 at 133 academic medical centers were evaluated using the University Health System Consortium discharge database. This study identified 386,377 older hospitalized patients with various solid tumors. Multivariate analyses were performed to determine variables independently associated with the primary endpoints: length of stay (LOS) ≥10 days and in-hospital mortality (IHM). Results: Average LOS was 7.5 days with 23% hospitalized ≥10 days. A significant improvement in LOS was observed over the study timeframe (p<.0001). Patients with gastric cancer had the greatest risk of prolonged LOS while those with breast cancer had the lowest risk. Additional risk factors for prolonged LOS included infection, venous thromboembolism and red blood cell transfusion (RBCT). The overall rate of IHM was 7.3% with a significant improvement in risk over the study timeframe (p<.0001). IHM was strongly associated with prolonged LOS (p<.0001). Older patients with primary central nervous system malignancies had the highest rates of IHM (OR=1.81; 95% CI: 1.59–2.07), followed by esophageal and lung cancer. Male gender was a risk factor for both IHM and prolonged LOS (p<.0001). Older African American cancer patients were more likely to experience prolonged LOS and IHM compared with Caucasian patients (p<.0001) after adjustment for cancer type and comorbidities. Additional risk factors associated with IHM included metastatic disease, active infection, neutropenia, renal disease, lung disease, arterial and venous thromboembolism, congestive heart failure, hepatic disease, and RBCT. Conclusions: Improving trends in LOS and IHM for older patients with solid tumors were observed over time in this study. Risk factors associated with IHM such as infection, neutropenia and RBCT, when modified, could potentially further reduce rates of prolonged LOS and IHM in older cancer patients. [Table: see text]