Temporal trends and regional variation in the use of palliative care after colorectal cancer surgery.

Abstract

Palliative care can improve patient satisfaction, decrease pain, and reduce costs but is relatively underused in colorectal surgery. We characterized patients with colorectal cancer undergoing surgery, hypothesizing regional and temporal differences in palliative care use. Patients with colorectal cancer undergoing colon resection, rectal resection, or ostomy formation were identified in the 2016-2021 National Inpatient Sample. The cohort was divided into elective and nonelective subgroups. The primary study end points were trends and regional differences in palliative care use. Multivariable regression models were developed to identify the independent association of palliative care with length of stay and costs. Of 599,275 adult patients undergoing surgery for colorectal cancer, 2.5% received palliative care. From 2016 to 2021, use of PC increased (2.1 vs 2.8%, nptrend <0.001). Patients in the Northeast less frequently received palliative care. A greater burden of comorbidities (Elixhauser: adjusted odds ratio, 1.10 per unit; 95% confidence interval, 1.05-1.16) was associated with a greater likelihood of receipt of palliative care in the elective cohort. Minority race (Black: adjusted odds ratio; 0.78, 95% confidence interval, 0.67-0.91; Hispanic: adjusted odds ratio, 0.78; 95% confidence interval, 0.66-0.92; Asian/Pacific Islander adjusted odds ratio, 0.76; 95% confidence interval, 0.58-0.98) and care at rural (adjusted odds ratio, 0.54; 95% confidence interval, 0.44-0.65) or urban non-teaching centers (adjusted odds ratio, 0.74; 95% confidence interval, 0.66-0.82) were associated with reduced odds of palliative care in the nonelective cohort. Patients receiving palliative care had increased LOS (β + 3.82 days, 95% confidence interval, 3.41-4.23) and hospitalization costs (β+$12,000, 95% confidence interval, $10,000-13,000). Palliative care after surgery for colorectal cancer has increased over time but remains infrequent. Minority race and geographic region remain associated with reduced use. Better characterization of factors influencing palliative care use and outcomes is needed.