title: A pre-operative nomogram for decision making in oncological surgical emergencies.
abstract: BACKGROUND
  The purpose of the study was to propose a clinical decision-making tool for predicting mortality in patients undergoing emergency abdominal surgery with a palliative intent in the oncology setting.
  
  
  METHODS
  Identification of all emergency surgical procedures performed in a Department of Oncologic Surgery in a Comprehensive Cancer Center between January 2008 and January 2013. Multivariate logistic and Cox regression models were used to identify factors predicitve of mortality at 3 months and survival probabilities. Models were internally validated using bootstrapping and calibration.
  
  
  RESULTS
  The mortality rates were 30% at 1 month, 46.7% at 3 months and 83.3% at the end of the study. One model based on the albumin level and the P-POSSUM score (AUC: 0.725) adequately predicted mortality at 3 months. A survival nomogram predicted mortality with a concordance index (CI) of 0.718, using the following factors: WHO performance status (P = 0.02), albumin level (P < 0.01) and P-POSSUM score (P < 0.01). The origin or the extent of the carcinoma did not own sufficient pronostic impact to be selected in this model.
  
  
  CONCLUSIONS
  Pre-operative mortality risk scores can be developed in a palliative context. Physicians counselling and surgical decision making should be based on the use of these tools.
authors.affiliation: Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Dumont
authors.forename: Chafika
authors.initials: C
authors.lastname: Mazouni
authors.forename: Georgina
authors.initials: G
authors.lastname: Bitsakou
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
authors.forename: Diane
authors.initials: D
authors.lastname: Goéré
authors.forename: Charles
authors.initials: C
authors.lastname: Honoré
authors.forename: Dominique
authors.initials: D
authors.lastname: Elias
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D004630:Emergencies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000601:surgery*; D049451:Nomograms; D011336:Probability; D016016:Proportional Hazards Models; D012372:ROC Curve
keywords: abdominal emergencies; nomogram; onoclogical; palliative