Failure to Thrive Following Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy: Causes and Consequences.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Apr 2022
Apr 2022
Historique:
received:
24
05
2021
accepted:
01
11
2021
pubmed:
7
1
2022
medline:
24
3
2022
entrez:
6
1
2022
Statut:
ppublish
Résumé
Failure to thrive (FTT) is a complex syndrome of nutritional failure and functional decline. Readmission for FTT following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS HIPEC) is common but underexamined. This study aims to determine features, risk factors, and prognostic significance of FTT following CRS HIPEC. We reviewed patients who underwent CRS HIPEC from 2010 to 2018 at our institution. Patients were categorized into no readmission, FTT readmission, and other readmission. FTT was determined by coding and chart review. We compared baseline characteristics, oncologic data, perioperative outcomes, and survival among the three cohorts. Of 1068 discharges examined, 379 patients (36%) were readmitted within 90 days, of which 134 (12.5%) were labeled as FTT. Patients with FTT readmission had worse preoperative functional status, higher rates of malnutrition, more complex resections, longer hospital stays, and more postoperative complications (all p < 0.001). Ostomy creation [relative risk ratio (RRR) 4.06], in-hospital venous thromboembolism (VTE), discharge to nursing home (RRR 2.48), pre-CRS HIPEC chemotherapy (RRR 1.98), older age (RRR 1.84), and female gender (RRR 1.69) were all independent predictors for FTT readmission on multinomial regression (all p < 0.01). FTT readmission was associated with worse median overall survival on multivariate analysis [hazard ratio (HR) 1.60, p < 0.001] after controlling for oncologic, perioperative, and baseline factors. FTT is common following CRS HIPEC and appears to be associated with baseline patient characteristics, operative burden, and postoperative complications. Perioperative strategies for improving nutrition and activity, along with early recognition and intervention in FTT may improve patient outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Failure to thrive (FTT) is a complex syndrome of nutritional failure and functional decline. Readmission for FTT following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS HIPEC) is common but underexamined. This study aims to determine features, risk factors, and prognostic significance of FTT following CRS HIPEC.
PATIENTS AND METHODS
METHODS
We reviewed patients who underwent CRS HIPEC from 2010 to 2018 at our institution. Patients were categorized into no readmission, FTT readmission, and other readmission. FTT was determined by coding and chart review. We compared baseline characteristics, oncologic data, perioperative outcomes, and survival among the three cohorts.
RESULTS
RESULTS
Of 1068 discharges examined, 379 patients (36%) were readmitted within 90 days, of which 134 (12.5%) were labeled as FTT. Patients with FTT readmission had worse preoperative functional status, higher rates of malnutrition, more complex resections, longer hospital stays, and more postoperative complications (all p < 0.001). Ostomy creation [relative risk ratio (RRR) 4.06], in-hospital venous thromboembolism (VTE), discharge to nursing home (RRR 2.48), pre-CRS HIPEC chemotherapy (RRR 1.98), older age (RRR 1.84), and female gender (RRR 1.69) were all independent predictors for FTT readmission on multinomial regression (all p < 0.01). FTT readmission was associated with worse median overall survival on multivariate analysis [hazard ratio (HR) 1.60, p < 0.001] after controlling for oncologic, perioperative, and baseline factors.
CONCLUSIONS
CONCLUSIONS
FTT is common following CRS HIPEC and appears to be associated with baseline patient characteristics, operative burden, and postoperative complications. Perioperative strategies for improving nutrition and activity, along with early recognition and intervention in FTT may improve patient outcomes.
Identifiants
pubmed: 34988834
doi: 10.1245/s10434-021-11100-z
pii: 10.1245/s10434-021-11100-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2630-2639Subventions
Organisme : NCI NIH HHS
ID : T32CA113263
Pays : United States
Organisme : NCI NIH HHS
ID : T32CA113263
Pays : United States
Informations de copyright
© 2021. Society of Surgical Oncology.
Références
Levine EA, Stewart JHT, Shen P, Russell GB, Loggie BL, Votanopoulos KI. Intraperitoneal chemotherapy for peritoneal surface malignancy: experience with 1000 patients. JACS. 2014;218(4):573–85. https://doi.org/10.1016/j.jamcollsurg.2013.12.013 .
doi: 10.1016/j.jamcollsurg.2013.12.013
Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22(16):3284–92. https://doi.org/10.1200/jco.2004.10.012 .
doi: 10.1200/jco.2004.10.012
pubmed: 15310771
Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H. 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2008;15(9):2426–32. https://doi.org/10.1245/s10434-008-9966-2 .
doi: 10.1245/s10434-008-9966-2
pubmed: 18521686
Choudry MHA, Shuai Y, Jones HL, et al. Postoperative complications independently predict cancer-related survival in peritoneal malignancies. Ann Surg Oncol. 2018;25(13):3950–9. https://doi.org/10.1245/s10434-018-6823-9 .
doi: 10.1245/s10434-018-6823-9
pubmed: 30302637
Pakraftar S, Ramalingam L, Shuai Y, et al. Institutional experience with ostomies created during cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion. Ann Surg Oncol. 2017;24(13):3811–7. https://doi.org/10.1245/s10434-017-6114-x .
doi: 10.1245/s10434-017-6114-x
pubmed: 29019111
Berger Y, Aycart S, Mandeli JP, Heskel M, Sarpel U, Labow DM. Extreme cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: outcomes from a single tertiary center. Surg Oncol. 2015;24(3):264–9. https://doi.org/10.1016/j.suronc.2015.06.013 .
doi: 10.1016/j.suronc.2015.06.013
pubmed: 26143715
Lee L, Alie-Cusson F, Dube P, Sideris L. Postoperative complications affect long-term outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis. J Surg Oncol. 2017;116(2):236–43. https://doi.org/10.1002/jso.24632 .
doi: 10.1002/jso.24632
pubmed: 28409831
Lee TC, Wima K, Sussman JJ, et al. Readmissions after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a US HIPEC collaborative study. J Gastrointest Surg. 2020;24(1):165–76. https://doi.org/10.1007/s11605-019-04463-y .
doi: 10.1007/s11605-019-04463-y
pubmed: 31745888
Dodson RM, McQuellon RP, Mogal HD, et al. Quality-of-life evaluation after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2016;23(Suppl 5):772–83. https://doi.org/10.1245/s10434-016-5547-y .
doi: 10.1245/s10434-016-5547-y
pubmed: 27638671
pmcid: 5391836
Martin AS, Abbott DE, Hanseman D, et al. Factors associated with readmission after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis. Ann Surg Oncol. 2016;23(6):1941–7. https://doi.org/10.1245/s10434-016-5109-3 .
doi: 10.1245/s10434-016-5109-3
pubmed: 26842489
Institute of Medicine (US) Committee on a National Research Agenda on Aging. National Academies Press (US): Committee on a National Research Agenda on Aging. Available from: https://www.ncbi.nlm.nih.gov/books/NBK234018/
Hodkinson HM. Non-specific presentation of illness. Br Med J. 1973;4(5884):94–6. https://doi.org/10.1136/bmj.4.5884.94 .
doi: 10.1136/bmj.4.5884.94
pubmed: 4542825
pmcid: 1587214
Xourafas D, Ablorh A, Clancy TE, Swanson RS, Ashley SW. Investigating transitional care to decrease post-pancreatectomy 30-day hospital readmissions for dehydration or failure to thrive. J Gastrointest Surg. 2016;20(6):1194–212. https://doi.org/10.1007/s11605-016-3121-3 .
doi: 10.1007/s11605-016-3121-3
pubmed: 26956005
Kent TS, Sachs TE, Callery MP, Vollmer CM Jr. Readmission after major pancreatic resection: a necessary evil? JACS. 2011;213(4):515–23. https://doi.org/10.1016/j.jamcollsurg.2011.07.009 .
doi: 10.1016/j.jamcollsurg.2011.07.009
Dawes AJ, Sacks GD, Russell MM, et al. Preventable readmissions to surgical services: lessons learned and targets for improvement. JACS. 2014;219(3):382–9. https://doi.org/10.1016/j.jamcollsurg.2014.03.046 .
doi: 10.1016/j.jamcollsurg.2014.03.046
Hu M, Jacobs BL, Montgomery JS, et al. Sharpening the focus on causes and timing of readmission after radical cystectomy for bladder cancer. Cancer. 2014;120(9):1409–16. https://doi.org/10.1002/cncr.28586 .
doi: 10.1002/cncr.28586
pubmed: 24477968
Eskander RN, Chang J, Ziogas A, Anton-Culver H, Bristow RE. Evaluation of 30-day hospital readmission after surgery for advanced-stage ovarian cancer in a medicare population. J Clin Oncol. 2014;32(36):4113–9. https://doi.org/10.1200/jco.2014.56.7743 .
doi: 10.1200/jco.2014.56.7743
pubmed: 25385738
pmcid: 4517941
Sarkisian CA, Lachs MS. Failure to thrive in older adults. Ann Intern Med. 1996;124(12):1072–8. https://doi.org/10.7326/0003-4819-124-12-199606150-00008 .
doi: 10.7326/0003-4819-124-12-199606150-00008
pubmed: 8633822
Robertson RG, Montagnini M. Geriatric failure to thrive. Am Fam Physician. 2004;70(2):343–50.
pubmed: 15291092
Kumeliauskas L, Fruetel K, Holroyd-Leduc JM. Evaluation of older adults hospitalized with a diagnosis of failure to thrive. Can Geriatr J. 2013;16(2):49–53. https://doi.org/10.5770/cgj.16.64 .
doi: 10.5770/cgj.16.64
pubmed: 23737929
pmcid: 3671012
Periyakoil VS. Frailty as a terminal illness. Am Fam Physician. 2013;88(6):363–8.
pubmed: 24134043
pmcid: 3992259
Mull HJ, Graham LA, Morris MS, et al. Association of postoperative readmissions with surgical quality using a Delphi consensus process to identify relevant diagnosis codes. JAMA Surg. 2018;153(8):728–37. https://doi.org/10.1001/jamasurg.2018.0592 .
doi: 10.1001/jamasurg.2018.0592
pubmed: 29710234
pmcid: 6142960
Donze J, Aujesky D, Williams D, Schnipper JL. Potentially avoidable 30-day hospital readmissions in medical patients: derivation and validation of a prediction model. JAMA Intern Med. 2013;173(8):632–8. https://doi.org/10.1001/jamainternmed.2013.3023 .
doi: 10.1001/jamainternmed.2013.3023
pubmed: 23529115
Turgeon MK, Gamboa AC, Lee RM, et al. The intersection of age and tumor biology with postoperative outcomes in patients after cytoreductive surgery and HIPEC. Ann Surg Oncol. 2020. https://doi.org/10.1245/s10434-020-08538-y .
doi: 10.1245/s10434-020-08538-y
pubmed: 33165719
pmcid: 7955158
Winer J, Zenati M, Ramalingam L, et al. Impact of aggressive histology and location of primary tumor on the efficacy of surgical therapy for peritoneal carcinomatosis of colorectal origin. Ann Surg Oncol. 2014;21(5):1456–62. https://doi.org/10.1245/s10434-013-3328-4 .
doi: 10.1245/s10434-013-3328-4
pubmed: 24201745
Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–51. https://doi.org/10.1016/0895-4356(94)90129-5 .
doi: 10.1016/0895-4356(94)90129-5
pubmed: 7722560
Subramaniam S, Aalberg JJ, Soriano RP, Divino CM. New 5-factor modified frailty index using American college of surgeons NSQIP data. JACS. 2018;226(2):173-81.e8. https://doi.org/10.1016/j.jamcollsurg.2017.11.005 .
doi: 10.1016/j.jamcollsurg.2017.11.005
Paul BK, Ihemelandu C, Sugarbaker PH. Prior surgical score: an analysis of the prognostic significance of an initial nondefinitive surgical intervention in patients with peritoneal carcinomatosis of a colorectal origin undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy. Dis Colon Rectum. 2018;61(3):347–54. https://doi.org/10.1097/dcr.0000000000001003 .
doi: 10.1097/dcr.0000000000001003
pubmed: 29420428
Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74. https://doi.org/10.1007/978-1-4613-1247-5_23 .
doi: 10.1007/978-1-4613-1247-5_23
pubmed: 8849962
Sugarbaker PH. Management of peritoneal-surface malignancy: the surgeon’s role. Langenbecks Arch Surg. 1999;384(6):576–87. https://doi.org/10.1007/s004230050246 .
doi: 10.1007/s004230050246
pubmed: 10654274
Dumitra S, O’Leary M, Raoof M, et al. The comprehensive complication index: a new measure of the burden of complications after hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2018;25(3):688–93. https://doi.org/10.1245/s10434-017-6157-z .
doi: 10.1245/s10434-017-6157-z
pubmed: 29260417
Prince Nelson SL, Ramakrishnan V, Nietert PJ, Kamen DL, Ramos PS, Wolf BJ. An evaluation of common methods for dichotomization of continuous variables to discriminate disease status. Commun Stat Theory Methods. 2017;46(21):10823–34. https://doi.org/10.1080/03610926.2016.1248783 .
doi: 10.1080/03610926.2016.1248783
pubmed: 29962658
pmcid: 6020169
Mosquera C, Vohra NA, Fitzgerald TL, Zervos EE. Discharge with pancreatic fistula after pancreaticoduodenectomy independently predicts hospital readmission. Am Surg. 2016;82(8):698–703.
doi: 10.1177/000313481608200827
pubmed: 27657584
Dworsky JQ, Shellito AD, Childers CP, et al. Association of geriatric events with perioperative outcomes after elective inpatient surgery. J Surg Res. 2021;259:192–9. https://doi.org/10.1016/j.jss.2020.11.011 .
doi: 10.1016/j.jss.2020.11.011
pubmed: 33302219
Dworsky JQ, Childers CP, Copeland T, et al. Geriatric events among older adults undergoing nonelective surgery are associated with poor outcomes. Am Surg. 2019;85(10):1089–93.
doi: 10.1177/000313481908501003
pubmed: 31657300
pmcid: 8019520
Kim NE, Hall JF. Risk factors for readmission after ileostomy creation: an NSQIP database study. J Gastrointest Surg. 2021;25(4):1010–8. https://doi.org/10.1007/s11605-020-04549-y .
doi: 10.1007/s11605-020-04549-y
pubmed: 32207078
Kelly KJ, Cajas L, Baumgartner JM, Lowy AM. Factors associated with 60-day readmission following cytoreduction and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2018;25(1):91–7. https://doi.org/10.1245/s10434-017-6108-8 .
doi: 10.1245/s10434-017-6108-8
pubmed: 29090402
Chen SY, Stem M, Cerullo M, et al. Predicting the risk of readmission from dehydration after ileostomy formation: the dehydration readmission after ileostomy prediction score. Dis Colon Rectum. 2018;61(12):1410–7. https://doi.org/10.1097/dcr.0000000000001217 .
doi: 10.1097/dcr.0000000000001217
pubmed: 30303886
pmcid: 6219896
Khan S, Kelly KJ, Veerapong J, Lowy AM, Baumgartner JM. Incidence, risk factors, and prevention strategies for venous thromboembolism after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2019;26(7):2276–84. https://doi.org/10.1245/s10434-019-07414-8 .
doi: 10.1245/s10434-019-07414-8
pubmed: 31065960
Hung YC, Wolf JH, D’Adamo CR, Demos J, Katlic MR, Svoboda S. Preoperative functional status is associated with discharge to nonhome in geriatric individuals. J Am Geriatr Soc. 2021. https://doi.org/10.1111/jgs.17128 .
doi: 10.1111/jgs.17128
pubmed: 33780000
Ramanathan R, Rieser C, Kurtom S, et al. Simplified preoperative tool predicting discharge destination after major oncologic gastrointestinal surgery. J Surg Oncol. 2019. https://doi.org/10.1002/jso.25767 .
doi: 10.1002/jso.25767
pubmed: 31792986
pmcid: 8022226
Hoang CM, Davids JS, Maykel JA, Flahive JM, Sturrock PR, Alavi K. Not all discharge settings are created equal: thirty-day readmission risk after elective colorectal surgery. Dis Colon Rectum. 2020;63(9):1302–9. https://doi.org/10.1097/dcr.0000000000001727 .
doi: 10.1097/dcr.0000000000001727
pubmed: 33216499
Narayanan S, Martin AN, Turrentine FE, Bauer TW, Adams RB, Zaydfudim VM. Mortality after pancreaticoduodenectomy: assessing early and late causes of patient death. J Surg Res. 2018;231:304–8. https://doi.org/10.1016/j.jss.2018.05.075 .
doi: 10.1016/j.jss.2018.05.075
pubmed: 30278945
pmcid: 8246070
Elias D, Souadka A, Fayard F, et al. Variation in the peritoneal cancer index scores between surgeons and according to when they are determined (before or after cytoreductive surgery). Eur J Surg Oncol. 2012;38(6):503–8. https://doi.org/10.1016/j.ejso.2012.01.001 .
doi: 10.1016/j.ejso.2012.01.001
pubmed: 22281154
de Boer NL, Brandt-Kerkhof ARM, Madsen EVE, Doukas M, Verhoef C, Burger JWA. The accuracy of the surgical peritoneal cancer index in patients with peritoneal metastases of colorectal cancer. Dig Surg. 2021;38(3):205–11. https://doi.org/10.1159/000513353 .
doi: 10.1159/000513353
pubmed: 33657551