How Does A Concurrent Diagnosis Of Cancer Influence Outcomes In Emergency General Surgery Patients?

Purpose A significant proportion of hospital admissions in the U.S. are secondary to emergency general surgery (EGS). The aim of this study is to quantify outcomes for EGS patients with cancer. Methods The Nationwide Inpatient Sample (2007-2011) was queried for patients with a diagnosis of an EGS co...

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Bibliographic Details
Published in:The American journal of surgery 2016-12, Vol.212 (6), p.1183-1193
Main Authors: Shah, Adil A., MD, Zafar, Syed Nabeel, MD, MPH, Ashfaq, Awais, MD, Chapital, Alyssa B., MD PhD, Johnson, Daniel J., MD, Stucky, Chee-Chee, MD, Pockaj, Barbara, MD, Gray, Richard J., MD, Williams, Mallory, MD, MPH, Cornwell, Edward E., MD, Wilson, Lori L., MD, Wasif, Nabil, MD, MPH
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Cancer
Case-Control Studies
Codes
Confidence intervals
Disparities
Emergencies
Emergency general surgery
Ethnicity
Failure to rescue
Female
Geography
Health care
Heart attacks
Hispanic people
Hospital costs
Hospitalization
Humans
Male
Middle Aged
Mortality
Neoplasms - complications
Neoplasms - mortality
Neoplasms - surgery
Outcome Assessment (Health Care)
Outcomes
Patients
Ratios
Surgery
Surgical outcomes
Uninsured people
United States
Young Adult
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Summary:Purpose A significant proportion of hospital admissions in the U.S. are secondary to emergency general surgery (EGS). The aim of this study is to quantify outcomes for EGS patients with cancer. Methods The Nationwide Inpatient Sample (2007-2011) was queried for patients with a diagnosis of an EGS condition as determined by the American Association for the Surgery of Trauma (AAST). 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 (LOS), and cost. Multivariable logistic regression analyses further adjusted for hospital characteristics and volume. Results Analysis 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 (OR[95%CI]:1.20[1.19-1.21]), mortality(OR[95%CI]:2.00[1.96-2.04]),failure-to-rescue(OR[95%CI]:1.52[1.48-1.56]), and prolonged hospital stay (OR[95%CI]:1.69[1.67-1.70]. Conclusion EGS patients with concurrent cancer have worse outcomes compared to patients without cancer after risk-adjustment.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2016.09.018