The impact of COVID‐19 on mortality, length of stay, and cost of care among patients with gastrointestinal malignancies: A propensity score‐matched analysis

• Type of Material: Article
• Authors: Mark B. Ulanja, CHRISTUS Ochsner St. Patrick Hospital; Bryce D. Beutler, University of Southern California; Kwabena Oppong Asafo-Agyei, CHRISTUS Highland Medical Center; Samuel B. Governor, Washington University in St. Louis; Samuel Edusa, Samalla Clinic Ltd.; Daniel Antwi-Amoabeng, CHRISTUS Ochsner St. Patrick Hospital; Reginald N. Ulanja, University of Cape Coast; Grace B. Nteim, University of Cape Coast; Millicent Amankwah, Louisiana State University; Vijay Neelam, CHRISTUS Ochsner St. Patrick Hospital; Ganiyu A. Rahman, University of Cape Coast; Francis T. Djankpa, University of Cape Coast; Tarig Mabrouk, CHRISTUS Ochsner St. Patrick Hospital; Olatunji Alese, Emory University
• Language: English
• Date: 2023-07-31
• Publisher: John Wiley and Sons Ltd.
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1002%2Fcam4.6355
• Title of Journal or Parent Work: Cancer Medicine
• Volume: 12
• Issue: 16
• Start Page: 17365
• End Page: 17376
• Keywords: SARS-CoV-2; gastrointestinal cancer; propensity score-matched anlaysis; mortality; healthcare cost disparity; impact of COVID-19 on gastrointestinal malignancies; COVID-19
• Research Categories: Health Sciences, Public Health; Health Sciences, Oncology

Abstract

Background Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and the coronavirus 19 (COVID‐19) pandemic have had a lasting impact on the care of cancer patients. The impact on patients with gastrointestinal (GI) malignancies remains incompletely understood. We aimed to assess the impact of COVID‐19 on mortality, length of stay (LOS), and cost of care among patients with GI malignancies, and identify differences in outcomes based on primary tumor site. Methods We analyzed discharge encounters collected from the National Inpatient Sample (NIS) between March 2020 and December 2020 using propensity score matching (PSM) and COVID‐19 as the treatment effect. Results Of the 87,684 patient discharges with GI malignancies, 1892 were positive for COVID‐19 (C+) and eligible for matching in the PSM model. Following PSM analysis, C+ with GI tumors demonstrated increased incidence of mortality compared to their COVID‐19‐negative (C‐) counterparts (21.3% vs. 11.9%, p < 0.001). C+ patients with colorectal cancer (CRC) had significantly higher mortality compared to those who were C‐ (40% vs. 24%; p = 0.035). In addition, C+ patients with GI tumors had a longer mean LOS (9.4 days vs. 6.9 days; p < 0.001) and increased cost of care ($26,048.29 vs. $21,625.2; p = 0.001) compared to C‐ patients. C+ patients also had higher odds of mortality secondary to myocardial infarction relative to C‐ patients (OR = 3.54, p = 0.001). Conclusions C+ patients with GI tumors face approximately double the odds of mortality, increased LOS, and increased cost of care compared to their C‐ counterparts. Outcome disparities were most pronounced among patients with CRC.