Prognostic significance and healthcare resource utilization of emergency department visit etiology in patients with prostate cancer.

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e23178 Background: Patients with prostate cancer (PC) frequently present to the emergency department (ED), yet the underlying reasons for these visits and their prognostic implications are not well characterized. We evaluated ED visit characteristics, outcomes, and survival according to visit etiology in patients with prostate cancer. Methods: Patients with PC presenting to the ED at our center were reviewed. ED visits were categorized as comorbidity-related (Co-R), disease-related (Ds-R), treatment-related (Tr-R), or other (Oth) based on ED clinical documentation and consultation notes. Classification was independently performed by an internist and a medical oncologist. Clinical characteristics, hospitalization rates, mortality, survival, and visit-related costs were analyzed. Results: Among 548 screened patients, 242 patients accounted for 510 ED visits. Visit etiologies were Co-R in 35.8%, Ds-R in 31.3%, Tr-R in 16.6%, and Oth in 18.3%. Metastatic disease at presentation was present in 48.9% of Co-R, 87.4% of Ds-R, 95.9% of Tr-R, and 53.8% of Oth visits. Common presenting symptoms included dyspnea (19.8%), chest pain (15.9%), and neurologic symptoms (15.4%) in Co-R; neurologic symptoms (15.7%), urinary retention (15.1%), and hematuria (15.1%) in Ds-R; nausea/vomiting (27.0%), fever (21.6%), and dyspnea (8.1%) in Tr-R; and falls (25.8%), abdominal pain (18.3%), and nausea/vomiting (10.8%) in Oth. Hospitalization rates were 39.0%, 37.7%, 36.5%, and 10.8%, while ED mortality rates were 3.3%, 1.9%, 4.1%, and 4.3% across Co-R, Ds-R, Tr-R, and Oth, respectively. Ninety-day mortality rates were 20.3%, 34.6%, 36.5%, and 17.2%. Compared with Co-R visits, Ds-R (HR:2.03, p < 0.001) and Tr-R (HR:1.93, p < 0.001) visits were independently associated with higher 90-day mortality, along with low hemoglobin (HR:0.85, p < 0.001), low albumin (HR:0.61, p < 0.001), and elevated liver function tests. Median survival after ED presentation was 28.5 months for Co-R, 7.2 months for Ds-R, 7.4 months for Tr-R, and 26.3 months for Oth (p < 0.001). Median ED visit costs were higher in Co-R and Ds-R visits than in Tr-R and Oth visits. Among hospitalized patients, total length of stay was longest in Ds-R (median 10 days, IQR 6–18; p = 0.03), whereas hospitalization costs were lowest in Tr-R (p = 0.022). Conclusions: ED visit etiology is a potent prognostic tool in PC. Ds-R and Tr-R visits represent clinical red flags for poor short-term survival, whereas comorbidity-related visits drive a substantial healthcare burden. Notably, one-quarter of non–disease-related visits were trauma-related, suggesting potentially preventable presentations. Proactive management of non-cancer comorbidities and fall-risk mitigation may reduce avoidable ED utilization, hospitalizations, and healthcare costs.

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