C. R. Horwood1, S. Byrd1, E. Schneider1, K. Woodling1, J. Wisler1, A. P. Rushing1 1Ohio State University,General Surgery,Columbus, OH, USA
Introduction:
With advances in cancer treatment, patients with active cancer are living longer and developing common conditions that fall outside the realm of oncologic treatment. There is little data describing the clinical decision-making and subsequent outcomes that occur in patients with cancer that present with an emergency general surgical diagnosis. The purpose of this study is to evaluate factors that determine operative management (OM) versus non-operative (NOM) management and subsequent outcomes of colonic emergencies within a cancer population.
Methods:
A single institution registry at a comprehensive cancer center was queried to identify patients with an active cancer diagnosis that had a surgical consult placed for one of three acute colonic surgical diagnoses between 2011 and 2016. The diagnoses included colitis (with or without peritonitis), bleeding diverticulosis, and diverticulitis. Records were retrospectively reviewed for patient demographics, baseline clinical characteristics, OM vs NOM interventions, and outcomes. Primary outcomes examined include hospital length of stay (LOS), 30-day mortality, disposition at discharge, and post-operative complications.
Results:
A total of 87 patients were evaluated of which 38 (43.7%) underwent OM vs 49 (56.3%) who underwent NOM. Differences in initial lab values included median white blood cell count (WBC) and median serum lactate. Median WBC was 8.1 in the OM group vs 4.6 in the NOM group, (p<0.001), and median serum lactate was 2.32 in the OM group vs 0.95 in the NOM group, (p<0.001). Thirteen patients had peritonitis at the time of surgical consult in the OM group vs zero in the NOM group, (p<0.001). With regard to post-operative outcomes, there was no difference in hospital LOS, but there was a difference in 30-day mortality and discharge to home between the groups. Median LOS in the OM group was 13.5 days vs 9 days in the NOM group (difference of 4.5 days, p=0.16). However, 30-day mortality was 32% in the OM group vs 6% in the NOM group (p=0.003) and discharge to home occurred in 35% of patients in the OM group compared to 80% in the NOM group (p<0.001). Within the OM group, 70% of patients had at least one post-operative complication.
Conclusion:
Not surprisingly, patients with higher WBCs, lactic acidosis, and peritonitis were more likely to undergo surgical intervention. Operative management was offered to sicker patients, and as a result, this group had a higher 30-day mortality and were less likely to be discharged home. While more work is needed to evaluate risk stratification for post-operative morbidity, particularly as it compares to non-cancer patients undergoing similar surgical procedures, these preliminary outcomes should be discussed with the active cancer patient prior to pursuing surgical intervention.