PURPOSE: To compare key hospitalization outcomes and cost between percutaneous ablation and external beam radiation therapy (EBRT) among patients admitted with acute cancer-related pain. MATERIALS AND METHODS: The Merative MarketScan Research Database was queried for all cancer-related hospitalizations from 2009 to 2022 for patients who underwent percutaneous palliative ablation or EBRT for painful bone or soft tissue tumors. Hospital length of stay (LOS), 30-day readmission rate, in-hospital mortality, and total hospitalization costs from the payor perspective were compared using multivariable generalized linear models controlling for patient demographics, comorbid conditions, geographic location, and calendar year. Sensitivity analyses were conducted using different model specifications and coarsened exact matching. RESULTS: Among 19,793 hospitalizations, patients underwent ablation in 185 (0.9%) cases and EBRT in 19,608 (99.1%) cases. Compared with EBRT, ablation was associated with shorter LOS (-2.0 days
95% CI, -3.9 to -0.03
P = .046), lower risk of in-hospital mortality (-3.4 percentage points [p.p.]
95% CI, -5.6 to -1.3
P = .002), lower risk of 30-day readmission (-7.4 p.p.
95% CI, -13.7 to -1.2
P = .019), and no statistically significant difference in total hospitalization costs (,379
95% CI, -1,947 to 18,706
P = .11). CONCLUSIONS: Less than 1% of patients hospitalized with acute cancer-related pain and treated with tumor-directed therapy (either via radiation oncology or interventional radiology) undergo percutaneous tumor ablation. In this study, percutaneous ablation was associated with shorter LOS, lower risk of in-hospital mortality, and lower risk of 30-day readmission.