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

Adil A. Shah, Syed Nabeel Zafar, Awais Ashfaq, Alyssa B. Chapital, Daniel J. Johnson, Chee Chee Stucky, Barbara A Pockaj, Richard J. Gray, Mallory Williams, Edward E. Cornwell, Lori L. Wilson, Nabil Wasif

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Abstract

Background 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. Methods The 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. 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 (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]). Conclusions EGS patients with concurrent cancer have worse outcomes compared with patients without cancer after risk-adjustment.

Original languageEnglish (US)
Pages (from-to)1183-1193
Number of pages11
JournalAmerican Journal of Surgery
Volume212
Issue number6
DOIs
StatePublished - Dec 1 2016

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Keywords

  • Cancer
  • Disparities
  • Emergency general surgery
  • Failure to rescue
  • Outcomes

ASJC Scopus subject areas

  • Surgery

Cite this

Shah, A. A., Zafar, S. N., Ashfaq, A., Chapital, A. B., Johnson, D. J., Stucky, C. C., Pockaj, B. A., Gray, R. J., Williams, M., Cornwell, E. E., Wilson, L. L., & Wasif, N. (2016). How does a concurrent diagnosis of cancer influence outcomes in emergency general surgery patients? American Journal of Surgery, 212(6), 1183-1193. https://doi.org/10.1016/j.amjsurg.2016.09.018