Background: Pancreatic cancer (PAC) is lethal cancer. Advanced PAC patients who have adopted hospice have experienced multiple hospitalizations for various complications and high rates of in-hospital mortality. However, it is not known which risk factors are associated with hospice patients' readmissions. This study aims to identify predictors of 30-day readmission and incidence of in-hospital mortality in hospice patients with PAC. Methods: A retrospective study of a nationally representative cohort of hospital admissions was conducted from January 1, 2017, to December 31, 2019. Data was collected from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database (NRD) between 2016 and 2018. We used the International Classification of Diseases, 10th revision (ICD–10) diagnostic codes to identify patients with malignant ascites (ICD-10 code "C25.9") and hospice status (ICD-10 code "Z51.5"). All adult patients ≥18 years were included in the study. To ensure at least 30 days of follow-up, patients were excluded if they were discharged during December. Our study examined predictors of 30-day readmission and incidence of in-hospital mortality among patients with pancreatic cancer receiving hospice care. Results: From 2017 to 2019, there were 240,107 index hospitalizations of patients with PAC, including 42,903 hospice patients. Patients with hospice status had an average age of 71 (63–80). A higher rate of cardiac arrhythmia, hypertension, liver disease, renal failure, and coagulopathy is observed in PAC patients with hospice (see Table 1). Inpatient mortality was significantly higher among hospice patients (24.5%, DNR status vs. 3.4%, full code; p< 0.001). The 30-day readmission rate was observed in 60,207 patients, with a significantly larger number of readmissions seen in PAC patients with hospice 13,551 (31.6%) compared to those without hospice 46,656 (23.7%), p 0.0001. Significant 30 days readmission predictors for PAC patients with hospice compared to PAC patients without hospice included infections (8.3% vs 3.4 %; p<0.0001), heart failure (3% vs 2%; p=0.04), and CVA (2.4% vs 0.8%; p<0.0001). Medicare was the primary payor in 55%, followed by private insurance 28.4%. Conclusion: This large nationwide study observed higher inpatient mortality and readmission rates in patients with PAC accepted hospice care utilizing hospital resources and healthcare costs.
HSR22-170 Table 1. Descriptive statistic of study population