Decreased trend in hospital mortality from pancreatic cancer despite increase in number of hospital admissions

• Published in: PloS one Vol. 13; no. 7; p. e0199909
• Main Authors: Bhandari, Sanjay, Abdul, Mubeen Khan Mohammed, Hollabaugh, Will, Sharma, Kanav, Evans, Douglas B, Guda, Nalini
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 18-07-2018; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Age; Aged; Aged, 80 and over; Analysis; Biology and Life Sciences; Cancer; Cancer therapies; Census of Population; Chemotherapy; Demographics; Diagnosis; Disease; Drug dosages; Engineering and Technology; Female; Gastroenterology; Government programs; Health care; Health care policy; Hospital admission and discharge; Hospital Mortality; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Humans; Insurance; Internal medicine; Male; Management; Medical diagnosis; Medicine; Medicine and Health Sciences; Middle Aged; Morbidity; Mortality; Multivariate analysis; Palliative care; Pancreatic cancer; Pancreatic Neoplasms - epidemiology; Pancreatic Neoplasms - mortality; Patient outcomes; Patients; Statistical analysis; Statistics; Surgery; Trends; United States; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0199909

Pancreatic cancer is one of the common cancers in US and is associated with high mortality and morbidity. The objectives of our study were to look at the recent trends in the number of hospitalizations with pancreatic cancer.
We identified patients with a discharge diagnosis of pancreatic cancer in the National Inpatient Sample from 2007 to 2011 using International Classification of Diseases-Clinical Modification, 9th revision (ICD-9-CM) codes. We looked at the yearly trend in the hospitalizations with pancreatic cancer and the outcomes which included length of stay (LOS), hospital charges and in-hospital mortality. We also performed multivariate analysis to look for the predictors of mortality.
There were 450, 414 patients with discharge diagnosis of pancreatic cancer. There was 18% increase in hospitalizations with pancreatic cancer in 2011 compared to 2007. Most of the patients were Caucasian (63%) with the mean age of 68 ± 0.14 years, had Medicare (57%) as primary insurance, were from Southern region (35%) and had higher Charlson Comorbidity Index (CCI) (87% with CCI > = 5). 6% underwent Whipple's procedure in the index hospitalization. After the adjustment for inflation, the mean hospital charges increased from $ 47,331 in 20007 to $ 53, 854 in 2011 (p = 0.01). LOS decreased from 7.31 ± 0.11 days in 2007 to 6.70 ± 0.09 days in 2011 (<0.001). Despite the increase in the number of hospitalizations of patients with pancreatic cancer, mortality decreased from 9.8% in 2007 to 8.1% in 2011 (p<0.001). On multivariate analysis, the independent factors associated with higher mortality were older age, male sex African-American race, insurance status other than Medicare, higher CCI and enrollment in palliative care. There was regional variation in mortality. Whipple's procedure conferred lower mortality.
Our study showed downward trends in LOS and in-hospital mortality despite increasing hospitalizations with pancreatic cancer.