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

Research output: Contribution to journalArticle

2 Citations (Scopus)

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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Emergencies
Neoplasms
Odds Ratio
Confidence Intervals
Length of Stay
Risk Adjustment
Propensity Score
Mortality
Intestinal Obstruction
International Classification of Diseases
Peritonitis
Inpatients
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)
Hemorrhage
Costs and Cost Analysis
Wounds and Injuries

Keywords

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

ASJC Scopus subject areas

  • Surgery

Cite this

How does a concurrent diagnosis of cancer influence outcomes in emergency general surgery patients? / Shah, Adil A.; Zafar, Syed Nabeel; Ashfaq, Awais; Chapital, Alyssa B.; Johnson, Daniel J.; Stucky, Chee Chee; Pockaj, Barbara A; Gray, Richard J.; Williams, Mallory; Cornwell, Edward E.; Wilson, Lori L.; Wasif, Nabil.

In: American Journal of Surgery, Vol. 212, No. 6, 01.12.2016, p. 1183-1193.

Research output: Contribution to journalArticle

Shah, AA, Zafar, SN, Ashfaq, A, Chapital, AB, Johnson, DJ, Stucky, CC, Pockaj, BA, Gray, RJ, Williams, M, Cornwell, EE, Wilson, LL & Wasif, N 2016, 'How does a concurrent diagnosis of cancer influence outcomes in emergency general surgery patients?', American Journal of Surgery, vol. 212, no. 6, pp. 1183-1193. https://doi.org/10.1016/j.amjsurg.2016.09.018
Shah, Adil A. ; Zafar, Syed Nabeel ; Ashfaq, Awais ; Chapital, Alyssa B. ; Johnson, Daniel J. ; Stucky, Chee Chee ; Pockaj, Barbara A ; Gray, Richard J. ; Williams, Mallory ; Cornwell, Edward E. ; Wilson, Lori L. ; Wasif, Nabil. / How does a concurrent diagnosis of cancer influence outcomes in emergency general surgery patients?. In: American Journal of Surgery. 2016 ; Vol. 212, No. 6. pp. 1183-1193.
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title = "How does a concurrent diagnosis of cancer influence outcomes in emergency general surgery patients?",
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.",
keywords = "Cancer, Disparities, Emergency general surgery, Failure to rescue, Outcomes",
author = "Shah, {Adil A.} and Zafar, {Syed Nabeel} and Awais Ashfaq and Chapital, {Alyssa B.} and Johnson, {Daniel J.} and Stucky, {Chee Chee} and Pockaj, {Barbara A} and Gray, {Richard J.} and Mallory Williams and Cornwell, {Edward E.} and Wilson, {Lori L.} and Nabil Wasif",
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T1 - How does a concurrent diagnosis of cancer influence outcomes in emergency general surgery patients?

AU - Shah, Adil A.

AU - Zafar, Syed Nabeel

AU - Ashfaq, Awais

AU - Chapital, Alyssa B.

AU - Johnson, Daniel J.

AU - Stucky, Chee Chee

AU - Pockaj, Barbara A

AU - Gray, Richard J.

AU - Williams, Mallory

AU - Cornwell, Edward E.

AU - Wilson, Lori L.

AU - Wasif, Nabil

PY - 2016/12/1

Y1 - 2016/12/1

N2 - 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.

AB - 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.

KW - Cancer

KW - Disparities

KW - Emergency general surgery

KW - Failure to rescue

KW - Outcomes

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