How does a concurrent diagnosis of cancer influence outcomes in emergency general surgery patients?
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.
Department of Surgery, Howard University Hospital and College of Medicine, Washington, DC, USA; Division of Surgical Oncology, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
Adil A
AA
Shah
Department of Surgery, Howard University Hospital and College of Medicine, Washington, DC, USA.
Syed Nabeel
SN
Zafar
Division of Surgical Oncology, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
Awais
A
Ashfaq
Division of Surgical Oncology, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
Alyssa B
AB
Chapital
Division of Surgical Oncology, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
Daniel J
DJ
Johnson
Division of Surgical Oncology, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
Chee-Chee
CC
Stucky
Division of Surgical Oncology, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
Barbara
B
Pockaj
Division of Surgical Oncology, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
Richard J
RJ
Gray
Department of Surgery, Howard University Hospital and College of Medicine, Washington, DC, USA.
Mallory
M
Williams
Department of Surgery, Howard University Hospital and College of Medicine, Washington, DC, USA.
Edward E
EE
Cornwell
Department of Surgery, Howard University Hospital and College of Medicine, Washington, DC, USA.
Lori L
LL
Wilson
Division of Surgical Oncology, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA. Electronic address: wasif.nabil@mayo.edu.
Nabil
N
Wasif
D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004630:Emergencies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D014481:United States; D055815:Young Adult
Cancer; Disparities; Emergency general surgery; Failure to rescue; Outcomes