Association of inpatient mortality and resource utilization with acute complications among colorectal cancer hospitalizations in the United States.

Abstract

e23220 Background: Hospitalization for colorectal cancer (CRC) is frequently complicated by acute clinical events. National data describing the relative contribution of specific complications to inpatient mortality and resource utilization remain limited. Methods: A serial cross-sectional analysis was conducted using the 2018–2022 Healthcare Cost and Utilization Project National Inpatient Sample. Adult hospitalizations with a principal diagnosis of CRC were identified. Acute complications were ascertained from secondary diagnosis codes and included bowel obstruction, bowel perforation, gastrointestinal bleeding, and sepsis. Outcomes included in-hospital mortality (primary), length of stay (LOS), and hospitalization cost estimated using cost-to-charge ratios. National estimates accounted for survey weighting, clustering, and stratification. Survey-weighted multivariable logistic regression evaluated associations between individual complications and in-hospital mortality, adjusting for demographics, payer, neighborhood income quartile, hospital teaching status, and calendar year. Results: From 2018–2022, 29.3% of CRC hospitalizations were complicated by at least one acute event. Bowel obstruction was the most common complication (18.9%), followed by gastrointestinal bleeding (8.9%), sepsis (3.1%), and bowel perforation (2.7%). Hospitalizations with any complication had longer LOS (10.08 vs 5.17 days) and higher mean costs ($37,106 vs $24,054) compared with uncomplicated admissions. Sepsis was associated with the greatest utilization burden (mean LOS 18.20 days; mean cost $73,304). In adjusted analyses, sepsis demonstrated the highest odds of in-hospital mortality (adjusted odds ratio [aOR] 14.23, 95% CI 12.80–15.82), followed by bowel perforation (aOR 1.84), gastrointestinal bleeding (aOR 1.44), and bowel obstruction (aOR 1.24) (all p < 0.001). Conclusions: Among CRC hospitalizations, acute complications were common and associated with substantially higher inpatient mortality and resource utilization. Sepsis, although less frequent, was associated with markedly elevated mortality and costs. These nationally representative findings provide benchmarking data on the inpatient burden associated with acute complications in colorectal cancer.