title: Indicators of surgery and survival in oncology inpatients requiring surgical evaluation for palliation.
abstract: BACKGROUND
  We sought to determine the clinical presentation, management, and outcomes associated with surgical consultation for symptom palliation in oncology inpatients.
  
  
  METHODS
  We reviewed the medical records of inpatients for whom surgical consultations were requested (January 2000 to September 2006) at a tertiary referral cancer center to identify those who underwent surgical palliative evaluation (defined as consultation for symptoms attributable to an advanced or incurable malignancy). We used the Cox proportional hazards model to identify prognostic factors associated with overall survival (OS) and logistic regression to identify factors associated with surgical intervention.
  
  
  RESULTS
  Surgical consultation was requested for 1,102 inpatients; 442 (40%) met the criteria for surgical palliative evaluation. Gastrointestinal obstruction was the most common complaint (43%), while wound complications/infection and gastrointestinal bleeding accounted for 10% and 8%, respectively. The median OS was 2.9 months. Adverse prognostic factors for OS included > or = 2 radiologically evident disease sites (HR = 1.4; 95% CI, 1.1-1.8) and carcinomatosis/sarcomatosis (HR = 1.4; 95% CI, 1.1-1.7). Palliative surgical procedures were performed in 119 (27%) patients, with a 90-day morbidity and mortality rate of 40% and 7% respectively. Patients with wound complications (OR = 3.3; 95% CI, 1.4-7.6), intestinal obstruction (OR = 1.9; 95% CI, 1.1-3.2), or an intact primary/recurrent tumor (OR = 3.6; 95% CI, 2.2-6.0) were more likely to undergo surgical intervention. Patients with ascites were less likely to undergo surgery (OR = 0.4; 95% CI, 0.2-0.8).
  
  
  CONCLUSIONS
  Surgical palliative evaluations accounted for 40% of inpatient surgical consultations. Given that OS in this population is short and surgery is associated with considerable morbidity and mortality, non-operative management is desirable.
authors.affiliation: Department of Surgical Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Badgwell
authors.forename: Kerrington
authors.initials: K
authors.lastname: Smith
authors.forename: Ping
authors.initials: P
authors.lastname: Liu
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
authors.forename: Steven A
authors.initials: SA
authors.lastname: Curley
authors.forename: Janice N
authors.initials: JN
authors.lastname: Cormier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000601:surgery*; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult