University of California Riverside School of Medicine Riverside, CA, United States
Mahesh Botejue, MD1, Rasiq Zackria, DO2, Scott Kubomoto, MD1 1University of California Riverside School of Medicine, Riverside, CA; 2Sunrise Health GME Consortium, Riverside, CA
Introduction: Periampullary cancers are responsible for >30,000 cancer related deaths in the US per year. The most common organ implicated is the pancreas, associated with the worst five-year mortality, while patients with primary duodenal etiology have the best five year survival rate, but are the rarest.
The method of treatment with the best outcomes is pancreaticoduodenectomy, but these patients still have less than 50% survival at five years. To this point no studies have shown prognostic significance for demographics or other related factors. We examine associated demographic, lab and socioeconomic factors in patients with periampullary carcinomas.
Methods: Deidentified patient information was obtained via data gathering software based on CPT codes. Of these, 16,075 patients were found to have a diagnosis of one periampullary carcinoma. 49 had sex missing, 793 had race missing, 4,375 had median income level missing, 687 were excluded due to diagnosis of other malignancy, immunosuppression, or lack of outcomes data. 355 were excluded due missing BMI or albumin levels, leaving us with 10,476 patients. Statistical analysis was done on commercially available software.
Results: 5597 (53.43%) patients were male and 4879 (46.57%) were female with an average age of 69.70 ± 11.60 years. 7265 (69.35%) patients were white, 1351 (12.90%) black, 1386 (13.23%) Hispanic, and 474 (4.52%) other race. The most common etiology of the periampullary carcinoma was pancreatic 9199 (87.81%), bile duct 620 (5.92%), duodenal 412 (3.93%), and ampullary 245 (2.34%). The median alkaline phosphatase (ALP) was 196.00 ± 378.38 and the median total bilirubin was 0.80 ± 5.62.
The average length of stay was 6.23 ± 6.48 days, with surgery the most common treatment option (50.63%). Patients paying through Medicaid were found to have the highest mortality rate (10.2%, p< 0.001). Patients in the highest income group ( >$100,000) were found to have a 30% lower rate of ER admission (OR=0.70, [95% CI (0.53, 0.93)], p = .013) and a length of stay 1.26 days shorter than the lowest income group ($19,000-$50,000).
Discussion: In our study we show that socioeconomic factors such as type of insurance billed and income levels can have a direct impact on mortality as well as admission to the hospital versus outpatient management of disease and length of stay. These factors can help clinicians understand risk factors for these patients, and subsequently allow us to choose appropriate treatment environments and to triage patients accordingly.
Mahesh Botejue indicated no relevant financial relationships.
Rasiq Zackria indicated no relevant financial relationships.
Scott Kubomoto indicated no relevant financial relationships.
Mahesh Botejue, MD1, Rasiq Zackria, DO2, Scott Kubomoto, MD1. P2110 - Socioeconomic and Demographic Factors in Patients With Periampullary Cancer, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.