Palliative care utilization and hospitalization outcomes among patients with renal cell carcinoma: A 2020-2022 National Inpatient Sample analysis.

Abstract

432 Background: Renal cell carcinoma (RCC) is an aggressive malignancy with significant symptom burden. Advances in targeted and immune-based therapies have improved survival, yet patients often experience complications that make early palliative care (PC) integration essential. This study evaluated inpatient outcomes and complications among RCC hospitalizations receiving PC in the United States (U.S.) from 2020 to 2022 using the National Inpatient Sample (NIS). Methods: A retrospective cohort study was conducted using the 2020-2022 NIS. Adult hospitalizations (≥18 years) with RCC (excluding renal pelvis) were identified by ICD-10 codes. PC use was defined by code Z51.5. Primary outcome was in-hospital mortality; secondary outcomes were length of stay (LOS), total charges, and complications (hypercalcemia, obstructive uropathy, spinal cord compression, malignant pleural effusion). Multivariable regression models adjusted for demographic, clinical, and hospital-level factors. Results: Among 271,515 RCC hospitalizations, 9.1% (24,745) received PC, indicating limited integration. PC was more common in older patients (≥65 years: 10.6% vs < 65 years: 7.0%; p < 0.05) and those with Medicare (10.2%) versus private (9.7%), Medicaid (6.4%), or self-pay (8.9%) (p < 0.05). Utilization did not differ by race (p = 0.19), sex (p = 0.20), or income quartile (p = 0.51), but increased with higher comorbidity burden (p < 0.05). On adjusted analyses, the PC group showed higher in-hospital mortality (OR 15.09, 95% CI 13.62–16.72; p < 0.05), longer hospital stays (+2.79 days, 95% CI 2.47–3.10; p < 0.05), and higher total charges (+$14,107, 95% CI $8,964–$19,249; p < 0.05). PC recipients also had higher odds of complications, including hypercalcemia (OR 2.71, 95% CI 2.40–3.05), obstructive uropathy (OR 1.34, 95% CI 1.19–1.52), spinal cord compression (OR 1.93, 95% CI 1.51–2.47), and malignant pleural effusion (OR 3.98, 95% CI 3.49–4.54) (p < 0.05 for all). Conclusions: PC recipients had higher mortality, longer stays, greater costs, and more complications, reflecting advanced disease and delayed referral rather than adverse effects of PC itself. Early consultation triggers for complications such as hypercalcemia, uncontrolled pain, and neurologic compromise, along with improved inpatient to outpatient continuity may facilitate timely PC integration and optimize resource utilization.