Background
Patients with advanced cancer and an abdominal surgical emergency pose a dilemma,
because rescue surgery may be futile. This study defines morbidity and mortality rates
and identifies preoperative risk factors that may predict outcome.
Methods
The National Surgical Quality Improvement Program database was queried for patients
with disseminated cancer undergoing emergent abdominal surgery (2005–2012). Preoperative
variables were used for prediction models for 30-day major morbidity and mortality.
A tree model and logistic regression were used to find factors associated with outcomes.
A training dataset was analyzed and then model performance was evaluated on a validation
dataset.
Results
Study patients had an overall 30-day major morbidity and mortality rate of 48.8% and
26%, respectively. The classification tree model for prediction for a morbidity involved
the following variables: sepsis, albumin, functional status, and transfusion (misclassification
rate, 36%). The tree model for mortality showed that an American Society of Anesthesiologists
(ASA) score of 4 or 5 with a dependent functional status to be predictive of mortality
(misclassification rate, 24%). There was agreement between models for predictive variables.
Conclusion
The decision to operate for an abdominal emergency in the setting of disseminated
cancer is difficult. Our study confirms the high risk for morbidity and mortality
in this population. Preoperative factors including sepsis, increased ASA class, low
serum albumin level, and patient functional dependence all predict poor outcomes.
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Article info
Publication history
Published online: June 16, 2015
Accepted:
April 22,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
