E227: Characterizing Conditional 90-Day Mortality and Associated Risk Factors Following Hepatobiliary and Pancreatic Cancer Surgery

ePoster Abstract Author(s)

Ace St. John, MD, MS (he/him/his)

Resident Physician
University of Maryland Medical Center, United States

Submitter(s)

Ace St. John, MD, MS (he/him/his)

Resident Physician
University of Maryland Medical Center, United States

Author(s)

Ace St. John, MD, MS (he/him/his)

Resident Physician
University of Maryland Medical Center, United States
Yinin Hu, MD (he/him/his)

Assistant Professor of Surgery
Department of Surgery, University of Maryland Baltimore, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center
Baltimore, Maryland, United States
JT

Julia Terhune, MD

Assistant Professor
University of Maryland Medical Center, United States
RW

Richelle Williams, MD (she/her/hers)

Assistant Professor
University of Maryland Medical Center, United States
CB

Cherif Boutros, MD

Faculty
University of Maryland School of medicine, United States
Nader Hanna, MD (he/him/his)

Professor of Surgery
Thomas Jefferson University
Philadelphia, Pennsylvania, United States
MS

Magesh Sundaram, MD

Associate Professor of Surgery
University of Maryland Medical Center, United States
Jason B. B. Fleming, MD (he/him/his)

GI Oncology
Moffitt Cancer Center, United States
DA

Daniel A. Anaya Saenz, MD, MSHCT

GI Oncology
Moffitt Cancer Center
Tampa, Florida, United States
BP

Benjamin Powers, MD

University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center
University of Maryland, United States

Introduction: Hepatopancreatobiliary (HPB) cancer surgery carries a high risk of morbidity and mortality. While prior studies indicate 90-day mortality rates are twice those of 30-day rates, they often include patients hospitalized beyond 30 days. No studies have yet assessed 90-day mortality in patients discharged post-operation. This study examines risk factors for such mortality in HPB surgery patients, hypothesizing that discharged patients may still face significant risks, with some factors increasing their 90-day mortality vulnerability.

Methods: The National Cancer Database (NCDB) was used to conduct a retrospective cohort study of patients who underwent curative-intent resection for hepatobiliary (hepatocellular carcinoma [HCC] and cholangiocarcinoma) and pancreatic cancers. The study included patients alive at 30-days from the index operation and discharged from the hospital. The dependent variable was conditional 90-day mortality. Descriptive analyses and multivariable logistic regression models were used to identify risk factors for 90-day mortality.

Results:

Of the 40,220 patients included, 3.1% faced 90-day mortality. In pancreatic and hepatobiliary groups, 90-day mortality was 3.19% and 2.68% respectively. Age notably impacted 90-day mortality in all patients. Pancreatic surgery patients had a median age of 67.0 (59.0-74.0) for survivors and 73.0 (66.0-79.0) for non-survivors (p< 0.001). For HCC and cholangiocarcinoma surgeries, mortality peaked at 3.70% for those aged >73(p=0.006). Pancreatic cancer patients with increased comorbidities, as shown by the Charlson Comorbidity Index and CACI, had higher mortality rates. An index of 3 had a 93.16% survival rate, compared to 97.26%, 96.35%, and 96.09% for indices of 0, 1, and 2, p< 0.001. Insurance Type (Medicare mortality at 4.21% vs. Private at 1.76%, p< 0.001), Facility Type (Community mortality at 5.25% vs. Academic at 2.67%, p< 0.001), and Clinical Stage (Stage III mortality at 4.42% vs. Stage I at 2.76%, p=0.015) also influenced 90-day mortality.

Conclusions: The proportion of patients experiencing conditional 90-day mortality after discharge for HPB surgery is roughly equivalent to the 30-day inpatient mortality rate. These data highlight ongoing risk of post-discharge mortality, especially among high-risk patients. Future studies should validate risk factors and pinpoint interventions like intensified follow-up and better care coordination to enhance post-discharge care for HPB surgery patients.

Learning Objectives:

Analyze the importance and implications of monitoring 90-day mortality rates in patients discharged after hepatopancreatobiliary (HPB) surgery.
Understand the impact of age, comorbidities, insurance type, facility type, and clinical stage on the 90-day mortality rates of patients who underwent HPB surgery.
Discuss potential strategies and interventions that can improve post-discharge outcomes, including intensified follow-up, enhanced care coordination, and targeted patient education.