The Changing Face Of Inpatient Cutaneous Cancer Care Of The Transplant Patient

Presentation: S126
Topic: Skin Cancers
Type: Oral
Date: Sunday, July 17, 2016
Session: 3:45 PM - 5:15 PM Skin
Authors: Thomas K Chung1, Cecelia Schmalbach2
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Institution(s): 1University of Alabama at Birmingham, 2Indiana University
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Objectives: Transplant recipients are known to have higher rates of cutaneous malignancies as a result of immunosuppression.  Few studies examine comorbidities and outcomes of this high-risk population.  This study aims to identify differences in outcomes between transplant and non-transplant patients undergoing surgical cutaneous cancer excision.

Study Design: Retrospective review of the Nationwide Inpatient Sample (NIS) from 2007 to 2011.

Methods: All patients requiring inpatient surgical excision of melanoma and non-melanoma cutaneous malignancies were identified.  Organ transplant patients (kidney, heart, lung, liver, bone marrow, and pancreas) were compared to non-transplant patients to identify differences in comorbidities, length of stay (LOS), hospital cost, post-operative complications, and mortality.  Subgroup analysis was performed for melanoma versus non-melanoma skin cancers. Data from individual years were compared to identify temporal trends.

Results: A total of 21,461 patients met inclusion criteria (12,741 non-melanoma skin cancer; 9,658 melanoma).  431 (2%) were solid organ transplant patients.  Overall, transplant patients were younger (65.4 vs 68.5 years, p<0.001), had more comorbidities (10.2 vs 7.1, p<0.001), and a significantly higher proportion of non-melanoma cutaneous malignancies (90% vs 58%, p<0.001).  Transplant patients had longer hospital stays (4.8 vs 4.2 days, p=0.019) and a higher rate of post-operative infection (p=0.02), but no significant differences in death.  Overall, higher hospital charges were found in the transplant group ($60,051 vs $43,424, p<0.001).   This difference is attributable to the non-melanoma skin cancer population ($62,830 vs $48,044; p<0.001), whereas no difference in cost was identified in the melanoma resections in transplant versus non-transplant patients (p=0.97).  Although transplant patient risk profiles remained unchanged from 2007-2011, an increase in complexity among the non-transplant cohort was identified.  Overall, year-to-year trends demonstrated a decrease in the number of cutaneous cancer cases necessitating inpatient surgery.

Conclusions: Solid organ transplant patients represent a small minority (2%) of patients requiring inpatient hospitalization for surgical management of cutaneous cancers.  This high-risk patient population carries an increased length of stay likely secondary to both increased comorbidities as well as a higher rate post-operative infection.  The overall higher hospital cost among transplant patients is predominantly explained by non-melanoma cases.  The overall number of inpatient surgical resection has decreased, possibly due to the expansion of ambulatory surgery centers.  Although comorbidities among the transplant cohort remained unchanged during the study period and the risk profile for non-transplant patients increased, complication rates and cost have improved for all patients in this study.