Association of protein-energy malnutrition with mortality, resource utilization, and discharge disposition in pancreatic cancer: An analysis of the National Inpatient Sample (NIS).

Abstract

e16364 Background: Pancreatic cancer is associated with substantial morbidity and mortality, with an overall 5-year survival relative survival of 12%. Protein-energy malnutrition (PEM) is a frequent complication of pancreatic cancer, and may worsen clinical outcomes. PEM has been linked to worse tolerance of oncologic therapies and increased morbidity, however its impact on in-hospital outcomes and discharge remains poorly defined at a national level. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (2016-2022). Adult hospitalizations with pancreatic cancer and PEM were identified using appropriate ICD-10-CM codes. Multivariable regression models were used to calculate adjusted odds ratios (aOR), identify predictors of PEM, and assess the impact of PEM on in-hospital mortality, hospital length of stay (LOS), discharge disposition, and total hospital charges among patients with pancreatic cancer. Results: Among 263,890 hospitalizations for pancreatic cancer, 71,475 (27.1%) had coexisting PEM Compared to patients without PEM, those with PEM had higher in-hospital mortality (7.9% vs 5.9%, p < 0.001), longer LOS (9.3 vs 6.1 days, p < 0.001) and higher total hospital charges ($116,316 vs $86,486, p < 0.001). After adjustment, PEM was found to be an independent predictor of increased in-hospital mortality (aOR 1.52, 95% CI 1.41-1.64) and discharge to a skilled nursing facility (aOR 1.94, 95% CI 1.82–2.07). PEM was associated with 45% longer LOS (adjusted incidence rate ratio 1.45, 95% CI 1.41-1.49) and 31% higher hospital charges (Exp[β] 1.31, 95% CI 1.27 – 1.35). Conclusions: PEM is common among hospitalized patients with pancreatic cancer and is independently associated with higher in-hospital mortality, prolonged hospitalization, greater healthcare utilization, and non-routine discharge. These findings highlight PEM as a major, potentially modifiable risk factor and support routine nutritional screening and early intervention as strategies to improve outcomes in this high-risk population. In-hospital outcomes and discharge disposition of patients with pancreatic cancer with and without protein-malnutrition. In-Hospital Outcomes and Discharge Disposition Without PEM(n = 192, 415) With PEM(n=71,475) P-Value Mortality, n (%) 10,040 (5.2) 5,665 (7.9) <0.001 Length of stay, mean (SD), days 6.1 ± 6.8 9.3 ± 9.4 <0.001 Total Charges, mean (SD), $ 86,486 ± 98,521 116 ± 142,876 < 0.001 Home (self-care) 110,285 (57.4) 26,950 (37.7) < 0.001 Short-term hospital 4,620 (2.4) 1,375 (1.9) <0.001 Skilled nursing facility 19,690 (10.2) 12,880 (18.0) <0.001 Home health care 46,475 (24.2) 24,270 (34.0) <0.001 AMA/Died 11,030 (5.7) 5,960 (8.3) <0.001 Abbreviations: PEM, protein-energy malnutrition; SD, standard deviation; AMA, against medical advice.