A Multi‐State Cohort Study of Hospital Utilization and Treatment Modality for Malignant Gastrointestinal Obstructions

INTRODUCTION: Malignant obstructions are associated with morbidity, mortality, and impaired quality of life with limited population-based data on practice patterns. We characterized the association between prior cancer-related hospitalizations and receipt of operative treatment for obstruction. METHODS: We performed a retrospective cohort study of patients hospitalized with malignant gastrointestinal obstructions from colorectal, gynecologic (GYN), and hepato-pancreatico-biliary (HPB) cancers in 12 states using the Healthcare Cost and Utilization Project State Inpatient Database, 2016-2020. The primary exposure was the number of cancer-related hospitalizations in the year prior to the first hospitalization for an obstruction. Risk-adjusted use of operative treatment during the index hospitalization, enrollment in hospice, length of stay, and inpatient mortality were examined using regression. RESULTS: Of 8665 patients, the median age was 67 years [Interquartile Range: 58,76]. There were 3789 patients with colorectal (43.7%), 2593 patients with GYN (29.9%), and 2337 patients (26.9%) with HPB cancers. The operative rate was 24.1%. Patients with prior hospitalizations were less likely to undergo operative treatment than those who were not previously hospitalized (operative rate difference: -7.8%, p < 0.001). Operative treatment was associated with longer median length of stay ( + 8.6 days, p < 0.001), lower rates of hospice enrollment (-3.0%, p = 0.002) and lower rates of inpatient mortality (operative rate difference -2.3%, p < 0.001). The time between readmissions also decreased with each recurrent obstruction in colorectal and GYN cancers. CONCLUSION: A greater number of previous cancer-related hospitalizations was associated with lower rates of operative treatment during the first hospitalization for a malignant obstruction. These data provide insight into the treatment trends for patients with malignant obstructions and may be helpful when counseling patients about the natural course of their disease.