How does a concurrent diagnosis of cancer influence outcomes in emergency general surgery patients?

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• 作者：Adil A. Shah ; M.D.^a ; ^b ; Syed Nabeel Zafar ; M.D. ; M.P.H.^a ; Awais Ashfaq ; M.D.^b ; Alyssa B. Chapital ; M.D. ; Ph.D.^b ; Daniel J. Johnson ; M.D.^b ; Chee-Chee Stucky ; M.D.^b ; Barbara Pockaj ; M.D.^b ; Richard J. Gray ; M.D.^b ; Mallory Williams ; M.D. ; M.P.H.^a ; Edward E. Cornwell III ; M.D.^a ; Lori L. Wilson ; M.D.^a ; Nabil Wasif ; M.D. ; M.P.H.^b ; ^{wasif.nabil@mayo.edu}
• 关键词：Emergency general surgery ; Cancer ; Outcomes ; Failure to rescue ; Disparities
• 刊名：The American Journal of Surgery
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：212
• 期：6
• 页码：1183-1193
• 全文大小：540 K
• 卷排序：212

文摘

A significant proportion of hospital admissions in the US are secondary to emergency general surgery (EGS). The aim of this study is to quantify outcomes for EGS patients with cancer.MethodsThe Nationwide Inpatient Sample (2007 to 2011) was queried for patients with a diagnosis of an EGS condition as determined by the American Association for the Surgery of Trauma. Of these, patients with a diagnosis of malignant cancers (ICD-9-CM diagnosis codes; 140-208.9, 238.4, 289.8) were identified. Patients with and without cancer were matched across baseline characteristics using propensity-scores. Outcome measures included all-cause mortality, complications, failure-to-rescue, length of stay, and cost. Multivariable logistic regression analyses further adjusted for hospital characteristics and volume.ResultsAnalysis of 3,625,906 EGS patients revealed an 8.9% prevalence of concurrent malignancies. The most common EGS conditions in cancer patients included gastro-intestinal bleeding (24.8%), intestinal obstruction (13.5%), and peritonitis (10.7%). EGS patients with cancer universally had higher odds of complications (odds ratio [OR] 95% confidence interval [CI]: 1.20 [1.19 to 1.21]), mortality (OR [95% CI]: 2.00 [1.96 to 2.04]), failure-to-rescue (OR [95% CI]: 1.52 [1.48 to 1.56]), and prolonged hospital stay (OR [95% CI]: 1.69 [1.67 to 1.70]).ConclusionsEGS patients with concurrent cancer have worse outcomes compared with patients without cancer after risk-adjustment.