D. Hayden1, M. Ostrowski2, T. Markossian3, J. Eberhardt1, T. Saclarides1 1Loyola University Medical Center,Department of General Surgery,Maywood, Illinois, USA 2Loyola University Medical Center,Stritch School Of Medicine,Maywood, Illinois, USA 3Loyola University Medical Center,Department Of Public Health Sciences,Maywood, Illinois, USA
Introduction: The treatment course of rectal cancer is long and wrought with morbidity. The burden of this disease is underappreciated and impacts patients, their families and the health care system.
Methods: Secondary analysis of the 2011 National Inpatient Sample was performed using the ICD-9CM codes for rectal cancer, most common secondary diagnoses and co-morbidities.
Results: For the 24,575 rectal cancer discharges in 2011, mean age was 64.2 (17-99); 58.1% were male. 69.8% were white, 9.3% black, 7.7% Hispanic and 2.8% Asian/Pacific Islander. 5.6% were obese and 3.1% morbidly obese. Most common comorbidity listed as the secondary diagnosis was hypertension (4.6%). 50.6% of patients resided in or near metropolitan areas with population ≥ 1 million; 16.5% from those 250,000-999,999, 9.7% from those 50,000-249,999 and 11.3% from micropolitan areas. Inpatient admissions seemed to be evenly distributed across income quartiles. Medicare (46.5%) and private insurance (36.8%) were most common; Medicaid accounted for 9.3% of payer distribution and 3.8% was self-pay. Admissions were most frequently elective (72.4%). Mean length of stay was 7.42 (0-277) days. 47.8% of patients were discharged home; 35.4% required home health nursing; 13.9% were transferred to rehab or skilled nursing. 2.4% of patients died during the hospital admission. For the obese and morbidly obese rectal cancer patients, LOS was increased: 8.27 days (0-64), were younger 60.4 (27-89), higher percentage were white (74.0%) and more had private insurance (48.6%, all p=0.00).
Conclusion: Rectal cancer impacts patients and the health care system due to lengthy hospitalizations and postoperative healthcare utilization of home health nursing and short-term facilities. Obesity and related comorbidities contribute to poorer outcomes; however, lifestyle interventions at diagnosis may decrease this burden.