Objective: The purpose of this study was to assess economic and clinical outcomes associated with inpatient colon cancer cases among persons 85 years and older in the U.S. from 2001-2010. We hypothesize that colon cancer is associated with higher inpatient charges and worse outcomes among those with infections compared to those without infections.

Methods: This retrospective cohort analysis utilized nationally-representative hospital discharge data from the Healthcare Cost and Utilization Project. Cases 85+ years of age with any diagnosis of colon cancer were included. Generalized linear models were used to assess outcomes of mortality, charges, and length of stay controlling for Elixhauser and predominant comorbidities, patient demographics, payer, year, and hospital characteristics.

Results: Of all adult colon cancer cases (n=1,846,363), 12.5% (n=230,133) occurred in persons 85+ years, averaging 88.7±3.2 years, 5.0±8.1 days for length of stay, and $55,485±67,938 in charges. Among the 9.5% (n=21,851) of inpatient mortality cases, predominant comorbidities included fluid and electrolyte disorders (60.7%), cardiac dysrhythmias (40.2%), heart failure (36.8%), distant metastases (33.5%), respiratory failure (31.8%), anemia (30.1%), surgical complications (28.8%), hypertension (28.3%), coronary atherosclerosis (25.7%), intestinal obstruction (25.6%), renal failure (25.3%), and sepsis (24.5%). Results of the multivariate binomial regression indicated that significantly increased odds of mortality (p<0.05) were particularly associated with comorbidities of heart failure, fluid and electrolyte disorders, paralysis, renal failure, wasting syndrome, respiratory failure, cardiac dysrhythmias, intestinal obstruction, sepsis, and metastases to the bone, liver and other digestive organs. Increased charges and lengths of stay were also associated with several clinical conditions, including various pulmonary diseases, surgical complications, end organ failure, sepsis, metastases, and other comorbidities (p<0.05).

Conclusions: Colon cancer has a large burden of illness among older persons. Continued research that seeks to risk stratify these cases based on comorbid conditions and complications should improve both clinical and economic outcomes in this vulnerable population.

Citation Format: Tomas Nuño, Grant Skrepnek. Predictors of inpatient mortality, charges, and length of stay among the very old with colon cancer in the United States. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A90.

©2015 American Association for Cancer Research.
2015