J. Chen3, C. R. Horwood1, S. A. Byrd2, G. Metzger1, R. G. Eaton3, A. P. Rushing1 1The Ohio State University,Division Of Trauma, Critical Care, And Burn,Columbus, OH, USA 2Indiana University,School Of Medicine,Indianapolis, IN, USA 3The Ohio State University,College Of Medicine,Columbus, OH, USA
Introduction:
Due to increasing technological and therapeutic advances, cancer is now shifting from an acute to a chronic care model. This leads to a potential increase in patients living with cancer who present with acute surgical emergencies such as appendicitis. However, clinical decision-making for these patients is largely anecdotal. The goal of this study was to evaluate a single institution’s appendectomy outcomes amongst patients with active cancer compared to those without cancer. We hypothesized that patients with cancer who underwent appendectomy for acute appendicitis would have similar surgical outcomes compared to patients without cancer.
Methods:
A single academic institution’s registry was queried to identify patients with and without active cancer who presented with a diagnosis of acute appendicitis and underwent emergent appendectomy between 2011 and 2016. Records were retrospectively reviewed for patient demographics, baseline clinical characteristics, pertinent oncologic information, intraoperative information, and outcomes. Primary outcomes included post-operative complications, need for additional invasive procedures, index-hospitalization mortality, hospital length of stay (LOS), and discharge disposition.
Results:
A total of 131 patients were included in the analysis; 19 patients had cancer (14.5%) and 112 did not have cancer (85.5%). The cancer cohort was older than the control group (51.7±15.3 vs 35.3±17.5, p<0.001). The cancer cohort had a lower median WBC (7.4 vs 13.0, p=0.045), lower median hemoglobin (13.0 vs 14.0, p=0.020), and lower median albumin (3.7 vs 4.4, p=0.026) compared to the control group. Cancer patients were also more likely to have higher ASA classifications than the control group (p<0.001) and were more likely to go to the ICU post-operatively (10.5% vs 1.8%, p=0.041). There was a slight difference in discharge disposition amongst the cancer group compared to the control group, with a slightly higher proportion of patients being discharged to a skilled nursing facility than home (2 vs 1 patient, p=0.022). There was no difference in post-operative complication rates (p=0.200), post-operative LOS (p=1.000), need for additional invasive procedures (p=1.000), or index-hospitalization mortality (1 death per group, p=0.270). There were no increased odds for index-hospitalization mortality (OR=6.17, p=0.205, 95% CI 0.37 to 103.06) or complications (OR=2.44, p=0.221, 95% CI 0.58 to 10.15) based on active cancer status.
Conclusion:
Despite differences in pre-operative characteristics between patients with and without cancer, post-operative outcomes were similar after emergency appendectomies. Thus, while more data is still needed, these preliminary outcomes suggest that patients with active cancer are not at greater risk for post-operative morbidity and mortality following emergent appendectomy for acute appendicitis.