In-hospital mortality after resection of biliary tract cancer in the United States
Authors
Carroll, James E. Jr.Hurwitz, Zachary M.
Simons, Jessica P.
McPhee, James T.
Ng, Sing Chau
Shah, Shimul A.
Al-Refaie, Waddah B.
Tseng, Jennifer F.
Document Type
Journal ArticlePublication Date
2010-02-01Keywords
Age FactorsAged
Biliary Tract Neoplasms
Biliary Tract Surgical Procedures
Chi-Square Distribution
Comorbidity
Female
Hospital Mortality
Hospitals
Humans
Logistic Models
Male
Middle Aged
Odds Ratio
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States
Epidemiology
Health Services Research
Surgery
Metadata
Show full item recordAbstract
OBJECTIVE: To assess perioperative mortality following resection of biliary tract cancer within the U.S. BACKGROUND: Resection remains the only curative treatment for biliary tract cancer. However, current data on operative mortality after surgical resections for biliary tract cancer are limited to small and single-center studies. METHODS: Using the Nationwide Inpatient Sample 1998-2006, a cohort of patient-discharges was assembled with a diagnosis of biliary tract cancer, including intrahepatic bile duct, extrahepatic bile duct, and gall bladder cancers. Patients undergoing resection, including hepatic resection, bile duct resection, pancreaticoduodenectomy, and cholecystectomy, were retained. The primary outcome measure was in-hospital mortality. Categorical variables were analyzed by chi-square. Multivariable logistic regression was performed to identify independent predictors of in-hospital mortality following resection. RESULTS: 31 870 patient-discharges occurred for the diagnosis of biliary tract cancer, including 36.2% intrahepatic ductal, 26.7% extrahepatic ductal, and 31.1% gall bladder. Of the total, 18.6% underwent resection: mean age was 69.3 years (median 70.0); 60.8% were female; 73.7% were white. Overall inpatient surgical mortality was 5.6%. Independently predictive factors of mortality included patient age >/=50 (vs./= 70 OR 9.03, 95% CI 2.86-28.56), the presence of identified comorbidities (congestive heart failure, OR 3.67, 95% CI 2.61-5.16; renal failure, OR 4.72, 95% CI 2.97-7.49), and admission designated as emergent (vs. elective; OR 1.82, 95% CI 1.39-2.37). CONCLUSION: Increased in-hospital mortality for patients undergoing biliary tract cancer resection corresponded to age, comorbidity, hospital volume, and emergent admission. Further study is warranted to utilize these observations in promoting early detection, diagnosis, and elective resection.Source
HPB (Oxford). 2010 Feb;12(1):62-7. Link to article on publisher's siteDOI
10.1111/j.1477-2574.2009.00129.xPermanent Link to this Item
http://hdl.handle.net/20.500.14038/49793PubMed ID
20495647Notes
Zachary Hurwitz participated in this study as a medical student as part of the Senior Scholars research program at the University of Massachusetts Medical School.
Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1111/j.1477-2574.2009.00129.x