Failure to screen: predictors and burden of emergency colorectal cancer resection.

OBJECTIVE

To evaluate predictors and burden of emergency colorectal cancer resection (E-CCR).

STUDY DESIGN

Cross-sectional study of 127,975 discharges of patients with colorectal cancer undergoing resection.

METHODS

We used the 2002 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project; E-CCR was identified based on the presence of bowel perforation, peritonitis, or obstruction. Bivariate and multilevel multivariable analyses were used to study the association between E-CCR and patient attributes, including demographics, insurance status, comorbidities, health status, and teaching hospital status.

RESULTS

Among younger patients, Medicaid enrollees (adjusted odds ratio [AOR], 2.08; 95% confidence interval [CI], 1.68-2.58) and the uninsured [AOR], 2.62; 95% CI, 2.05-3.34) were at higher risk for E-CCR. Among older patients, those dually eligible for Medicare and Medicaid were at higher risk for E-CCR (AOR, 1.37; 95% CI, 1.11-1.70). Emergency colorectal cancer resection was associated with greater than 3-fold increased in-hospital mortality, 54 979 (95% CI, 38 731-71 226) excess hospital days as a result of longer lengths of stay, and more than 250 million dollars (95% CI, 180 million-334 million dollars) in hospital charges.

CONCLUSION

Targeted interventions to increase colorectal cancer screening in vulnerable subgroups of the population would reduce the substantial patient and societal burden associated with failure to screen.