title: Should we operate for an intra-abdominal emergency in the setting of disseminated cancer?
abstract: BACKGROUND
  Patients with advanced cancer and an abdominal surgical emergency pose a dilemma, because rescue surgery may be futile. This study defines morbidity and mortality rates and identifies preoperative risk factors that may predict outcome.
  
  
  METHODS
  The National Surgical Quality Improvement Program database was queried for patients with disseminated cancer undergoing emergent abdominal surgery (2005-2012). Preoperative variables were used for prediction models for 30-day major morbidity and mortality. A tree model and logistic regression were used to find factors associated with outcomes. A training dataset was analyzed and then model performance was evaluated on a validation dataset.
  
  
  RESULTS
  Study patients had an overall 30-day major morbidity and mortality rate of 48.8% and 26%, respectively. The classification tree model for prediction for a morbidity involved the following variables: sepsis, albumin, functional status, and transfusion (misclassification rate, 36%). The tree model for mortality showed that an American Society of Anesthesiologists (ASA) score of 4 or 5 with a dependent functional status to be predictive of mortality (misclassification rate, 24%). There was agreement between models for predictive variables.
  
  
  CONCLUSIONS
  The decision to operate for an abdominal emergency in the setting of disseminated cancer is difficult. Our study confirms the high risk for morbidity and mortality in this population. Preoperative factors including sepsis, increased ASA class, low serum albumin level, and patient functional dependence all predict poor outcomes.
authors.affiliation: Department of Surgery, University of Utah, Salt Lake City, UT. Electronic address: Courtney.Scaife@hci.utah.edu.
authors.forename: Courtney L
authors.initials: CL
authors.lastname: Scaife
authors.affiliation: Department of Surgery, University of Utah, Salt Lake City, UT.
authors.forename: Kelly
authors.initials: K
authors.lastname: Hewitt
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, UT.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Sheng
authors.affiliation: Department of Surgery, University of Utah, Salt Lake City, UT.
authors.forename: Katie W
authors.initials: KW
authors.lastname: Russell
authors.affiliation: Department of Surgery, University of Utah, Salt Lake City, UT.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Mone
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery*; D000008:Abdominal Neoplasms / Q000150:complications / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D057234:Preoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult