Predictors of readmission and readmission-related mortality in older adults with pancreatic adenocarcinoma: Role of palliative care and discharge disposition.

Abstract

788 Background: Patients with pancreatic adenocarcinoma are often faced with a multitude of symptoms. This often results in significant deterioration in quality of life and need for inpatient hospitalizations, especially among older patients. Identifying predictors of early re-hospitalization and readmission-related mortality is essential to guide palliative care integration and optimize discharge planning, yet data in this population remain limited. Methods: The Nationwide Readmissions Database (2017–2018) was queried for all hospitalizations of patients aged ≥75 years with pancreatic adenocarcinoma. Index admissions were identified, and patients who died during the index admission were excluded. The final analytic cohort included 43,528 patients. Subgroups included those readmitted within 30 days and those with 30-day readmission-associated mortality. Multivariable logistic regression was performed adjusting for age, sex, comorbidity burden, and discharge disposition to produce adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results: Among 47,345 index admissions, 3,817 (8.1%) experienced mortality the index hospitalization, leaving 43,528 patients for analysis. Discharge disposition included routine discharge (35.8%), transfer to short-term hospitals (1.3%), skilled nursing facilities (22.1%), home health care (32.3%), and discharge against medical advice (0.3%). Overall, 5,899 (13.6%) patients were readmitted within 30 days, of which, 702 (11.9%) died during the readmission. Predictors of lower 30-d readmission included female sex (aOR 0.86, 95% CI 0.82–0.91), disposition to skilled nursing facilities (aOR 0.41, 95% CI 0.38–0.45), home health care (aOR 0.63, 95% CI 0.59–0.67), and receipt of palliative care consultation during the index admission (aOR 0.34, 95% CI 0.31–0.37). Similarly, lower odds of readmission-related mortality were observed among patients discharged to home health care (aOR 0.73, 95% CI 0.61–0.88) and those receiving palliative care consultation during index readmission (aOR 0.63, 95% CI 0.51–0.78). Conclusions: In older adults with pancreatic cancer, discharge disposition and early palliative care involvement are strongly associated with reduced risks of 30-day readmission and readmission-related mortality. These findings underscore the importance of tailored discharge planning and proactive integration of palliative care to improve outcomes in this vulnerable population.