Inpatient Versus Outpatient Diagnosis of Gastric Adenocarcinoma: Differences in Stage, Risk Factors, and Surgical Outcomes

Purpose There is no standard gastric cancer screening in the United States. To understand populations at risk, we describe patients by diagnosis setting. Methods Single-institution, retrospective cohort study (2016-2023). Adults who underwent surgery for gastric adenocarcinoma. Results Patients with inpatient diagnoses of gastric cancer (n = 29) were less likely to be Asian (62% vs 82%, P = 0.009) or have family history (17% vs 45%, P = 0.006), and more likely to have non-curative surgery (24% vs 2%, P < 0.001), higher pathological stage (54% vs 23%, P = 0.002), lymphovascular invasion (52% vs 21%, P = 0.005), longer length of stay (8 days [IQR 5.5-16.5] vs 5 days [IQR 4.0-7.0], P < 0.001), and 90-day postoperative complications (40% vs 21%, P = 0.048). Conclusion Patients diagnosed with gastric cancer in the inpatient setting represent a distinct cohort not captured by risk indicators (family history, East Asian ancestry, prior H. pylori) that prompt opportunistic endoscopic evaluation in the absence of US screening guidelines. Subgroups may benefit from targeted screening.