M. R. Egyud1, M. Plocienniczak2, C. James2, T. Sachs1,2, T. Dechert1,2 1Boston Medical Center,Department Of Surgery,Boston, MA, USA 2Boston University School Of Medicine,Boston, MA, USA
Introduction: The nature of Trauma and Acute Care Surgery (TACS) demands surgeons be able to diagnose and treat a spectrum of disease in complex patients with multi-organ involvement. The proportion of these patients with undiagnosed malignancy is poorly understood. We sought to evaluate the role TACS plays in the early surgical management of patients presenting with undiagnosed malignancy.
Methods: We reviewed records of all patients at an urban tertiary care center, evaluated by TACS for potential operative intervention between 01/2005 and 09/2015. Patients were selected if a malignancy was diagnosed during admission (Cohort A) or within a year of discharge based on findings from the index admission (Cohort B). Cohorts were compared by demographics, type of insurance, comorbidities, operation(s) performed, and hospital course.
Results: We identified 247 patients, with 54% in Cohort A (n=134) and 46% in Cohort B (n=113). The majority of patients (> 80%) in both cohorts used Medicare, Medicaid, or lacked insurance. There were 21 distinct malignancies identified in Cohort A, with the majority (n=97, 72%) being of gastrointestinal origin. 26 distinct malignancies were identified in Cohort B. Cohort A patients tended to present with more advanced cancers, while Cohort B were earlier stage (Figure 1). Of the Cohort A patients, 111 (83%) required an operation related to their malignancy, 61 (55%) of whom needed an urgent operation.
Conclusion: Patients presenting to TACS may have an undiagnosed malignancy, many of whom are indigent or poor. A portion of these patients will require an urgent operation. In addition, TACS surgeons often initiate workup for suspicious findings and coordinate care to ensure these patients receive appropriate evaluation in a timely fashion. The underserved are known to present at later stage and have less access to screening and prevention, and further study is needed to improve outcomes in this patient population.
