Emergency department visits and inpatient hospitalizations among older patients with brain metastases: a dual population- and institution-level analysis

Nayan Lamba; Paul J Catalano; Colleen Whitehouse; Kate L Martin; Mallika L Mendu; Daphne A Haas-Kogan; Patrick Y Wen; Ayal A Aizer

doi:10.1093/nop/npab029

Emergency department visits and inpatient hospitalizations among older patients with brain metastases: a dual population- and institution-level analysis

Neurooncol Pract. 2021 May 21;8(5):569-580. doi: 10.1093/nop/npab029. eCollection 2021 Oct.

Authors

Nayan Lamba^{1

2}, Paul J Catalano³, Colleen Whitehouse², Kate L Martin², Mallika L Mendu⁴, Daphne A Haas-Kogan², Patrick Y Wen⁵, Ayal A Aizer²

Affiliations

¹ Harvard Radiation Oncology Program, Harvard University, Boston, Massachusetts, USA.
² Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts, USA.
³ Department of Biostatistics, Harvard T.H. Chan School of Public Health, and Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
⁴ Partners Healthcare Center for Population Health Management and Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁵ Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA.

Abstract

Background: Older patients with brain metastases (BrM) commonly experience symptoms that prompt acute medical evaluation. We characterized emergency department (ED) visits and inpatient hospitalizations in this population.

Methods: We identified 17 789 and 361 Medicare enrollees diagnosed with BrM using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2010-2016) and an institutional database (2007-2016), respectively. Predictors of ED visits and hospitalizations were assessed using Poisson regression.

Results: The institutional cohort averaged 3.3 ED visits/1.9 hospitalizations per person-year, with intracranial disease being the most common reason for presentation/admission. SEER-Medicare patients averaged 2.8 ED visits/2.0 hospitalizations per person-year. For patients with synchronous BrM (N = 7834), adjusted risk factors for ED utilization and hospitalization, respectively, included: male sex (rate ratio [RR] = 1.15 [95% CI = 1.09-1.22], P < .001; RR = 1.21 [95% CI = 1.13-1.29], P < .001); African American vs white race (RR = 1.30 [95% CI = 1.18-1.42], P < .001; RR = 1.25 [95% CI = 1.13-1.39], P < .001); unmarried status (RR = 1.07 [95% CI = 1.01-1.14], P = .02; RR = 1.09 [95% CI = 1.02-1.17], P = .01); Charlson comorbidity score >2 (RR = 1.27 [95% CI = 1.17-1.37], P < .001; RR = 1.36 [95% CI = 1.24-1.49], P < .001); and receipt of non-stereotactic vs stereotactic radiation (RR = 1.44 [95% CI = 1.34-1.55, P < .001; RR = 1.49 [95% CI = 1.37-1.62, P < .001). For patients with metachronous BrM (N = 9955), ED visits and hospitalizations were more common after vs before BrM diagnosis (2.6 vs 1.2 ED visits per person-year; 1.8 vs 0.9 hospitalizations per person-year, respectively; RR = 2.24 [95% CI = 2.15-2.33], P < .001; RR = 2.06 [95% CI = 1.98-2.15], P < .001, respectively).

Conclusions: Older patients with BrM commonly receive hospital-level care secondary to intracranial disease, especially in select subpopulations. Enhanced care coordination, closer outpatient follow-up, and patient navigator programs seem warranted for this population.

Keywords: brain metastases; emergency department; hospitalization; population.

© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved. For permissions, please e-mail: [email protected].