Emergency presentation and inpatient vulnerability in sinonasal malignancies: National evidence of a diagnostic delay phenotype.

Abstract

e23248 Background: Sinonasal malignancies are rare, heterogeneous tumors characterized by nonspecific early symptoms and frequent diagnostic delay, leading to advanced disease at presentation. While outpatient management and multimodal therapy have been extensively reviewed, national inpatient presentation patterns and rescue outcomes remain poorly defined. Methods: A survey-weighted analysis of the National Inpatient Sample from 2016–2023 was performed, identifying adult hospitalizations with sinonasal malignancies (C30–C31) in any diagnosis position and excluding admissions with palliative care coding. A diagnostic delay phenotype was defined by nonelective admission accompanied by acute organ failure at presentation, including sepsis, shock, respiratory failure, or acute kidney injury. Outcomes included in-hospital mortality, ICU escalation, failure-to-rescue (death following a major complication), length of stay, hospitalization cost, and discharge disposition. Outcomes were contextualized through comparisons with other rare cancers and common malignancies. Results: Sinonasal malignancies accounted for 0.66% (95% CI, 0.64%–0.69%) of cancer hospitalizations and were predominantly nonelective at 57.16% (95% CI, 55.63%–58.69%). Acute organ failure at presentation occurred in 21.53% (95% CI, 20.34%–22.72%) of sinonasal admissions, with sepsis in 7.70% (95% CI, 6.93%–8.46%) and respiratory failure in 8.77% (95% CI, 7.98%–9.56%). Overall in-hospital mortality was 1.64% (95% CI, 1.33%–2.02%). Among admissions with major complications, failure-to-rescue mortality was 4.23% (95% CI, 3.39%–5.27%). ICU escalation occurred in 4.93% (95% CI, 4.33%–5.52%), with post-ICU mortality of 27.74% (95% CI, 26.25%–29.27%). Compared with common cancers, sinonasal malignancies demonstrated higher rates of nonelective admission and acute organ failure but similar overall mortality, indicating preserved rescue despite high-acuity presentation. Conclusions: Sinonasal malignancies exhibit a distinct inpatient diagnostic delay phenotype marked by emergency presentation and acute organ failure at admission. Despite high physiologic acuity, inpatient mortality and failure-to-rescue are not disproportionately worse, suggesting that delayed recognition primarily shifts how patients present rather than whether they survive hospitalization. These findings complement existing clinical literature by identifying inpatient presentation and rescue as critical, understudied dimensions of sinonasal cancer care.