Raja Chandra Chakinala, MD1, Khwaja F. Haq, MD2, Shantanu Solanki, MD, MPH3, Asim Kichloo, MD4, Harshil Shah, MD1, Jagmeet Singh, MD1, Achint Patel, MD, MPH5, Abhishek Bhurwal, MBBS, MD6, Shanza Waqar, MD7, Zarak Khan, MD8, Faiza Bhatti, MD2; 1Guthrie/Robert Packer Hospital, Sayre, PA; 2Henry Ford Hospital/Wayne State University, Detroit, MI; 3Geisinger Commonwealth School of Medicine, Sayre, PA; 4Central Michigan University School of Medicine, Saginaw, MI; 5Sayre, PA; 6Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; 7Medcare Clinics, St. Catherines, ON, Canada; 8St. Mary Mercy Hospital, Livonia, MI
Introduction: Anal cancer is an uncommon type of gastrointestinal malignancy that occurs in the anal canal and potentially cause signs and symptoms such as rectal bleeding and anal pain. Limited epidemiological data exist on cost of care and outcomes for hospitalizations with anal cancer. Methods: National Inpatient Sample (NIS) database was analyzed during the period from 2001-2011 for all subjects with the diagnosis of anal cancer (ICD-9 code 154.3) as primary or secondary diagnosis. Nationwide Inpatient Sample (NIS) is the largest inpatient care database in the United States. Its large sample size is ideal for developing national and regional estimates. Cochran-Armitage trend test was used for determining statistical significance of variation. Results: In 2001, there were 2,943 hospitalizations with anal cancer as compared to 5,587 in 2011 (p< 0.0001, figure 1A). Age group 50-64 remained the most commonly affected with rising proportional trend from 32.5% in 2001 to 41.0% in 2011 (p< 0.0001, figure 1B). Throughout the study period, more women (about two thirds each year) were hospitalized with anal cancer as compared to men (p< 0.0001, figure 1C). Caucasians remained the most commonly affected race with a slight decrease in proportional trend from 78.4% in 2001 to 74.5% in 2011 (p< 0.0001). Southern US remained to have more anal cancer-related hospitalizations as compared to other regions, however, over the study period there was a decline in hospitalization rate from 44.7% in 2001 to 38.8% in 2011 (p< 0.0001). In- hospital mortality decreased from 3.2% in 2001 to 2.7% in 2011 (p< 0.0001) and average length of stay increased from 6.5 days in 2001 to 7.4 days in 2011 (p=0.63). Cost per hospitalization increased from $10,749 in 2001 to $15,394 in 2011 (adjusted for inflation, p< 0.0001, figure 1D). Analysis of the Agency for Healthcare Research and Quality (AHRQ) comorbidity measures revealed hypertension, fluid & electrolyte disorders, and deficiency anemias as some of the more commonly associated comorbidities with metastatic cancer showing increasing association over time (figure 2). Discussion: Significant rise in the number of hospitalizations with anal cancer was found with interesting demographic variations and association with comorbidities. Although in-hospital mortality decreased, there was a noteworthy rise in the cost of care. Further studies are needed to identify potential predictors & factors responsible for such results to better elucidate our findings.
Disclosures: Raja Chandra Chakinala indicated no relevant financial relationships. Khwaja Haq indicated no relevant financial relationships. Shantanu Solanki indicated no relevant financial relationships. Asim Kichloo indicated no relevant financial relationships. Harshil Shah indicated no relevant financial relationships. Jagmeet Singh indicated no relevant financial relationships. Achint Patel indicated no relevant financial relationships. Abhishek Bhurwal indicated no relevant financial relationships. Shanza Waqar indicated no relevant financial relationships. Zarak Khan indicated no relevant financial relationships. Faiza Bhatti indicated no relevant financial relationships.