C. R. Ledet1, D. A. Santos1, A. R. Limmer1, H. M. Gibson1, B. D. Badgwell1 1University Of Texas MD Anderson Cancer Center,Surgical Oncology,Houston, TX, USA
Introduction:
Cancer is the second leading cause of death in the United States. Recently, cancer patients have benefited from advancements in both diagnostic tools and therapies, which often extend both disease-free and overall survival. As a result, a number of cancer patients are living longer with solid and hematologic malignancies. Cancer patients frequently require general surgical consultation for conditions that arise during their treatment, or as a consequence of therapy. In addition, general surgeons are frequently consulted for long-term complications of oncologic surgery. However, acute care general surgery services are infrequently described in cancer centers that are not affiliated with a general hospital. The purpose of this study was to determine the clinical presentation and management associated with cancer patients requiring acute care general surgery consultation at a free-standing cancer center.
Methods:
We performed a retrospective review of the general surgery consult database at our free-standing cancer center from 10/2015-8/2017. All patients included in the database are patients that have a suspicion of cancer, actively being treated for malignancy or in long-term surveillance. Clinical, demographic, and treatment variables were extracted for patients undergoing general surgical consultation. The wait time for outpatient vascular access placement was recorded to evaluate a change during the study period.
Results:
In 2015, the acute care general surgery service was initiated at our institution. There was a 60% increase in general surgical consults during the study period (212 vs. 542 consults). Over 95% of the general surgical cases were elective outpatient surgeries, while only 2-4% of cases were emergent. In 2017, almost 50% of the elective cases were comprised of vascular access placement for chemotherapy. With the addition of acute care surgeons, the average wait time for vascular access decreased by more than 50%, median wait time in 2015, 2.2 days ( 1.9-4.3 days) vs. 0.96 days (0.56-2.33 days) in 2017. Open and minimally invasive inguinal, umbilical, parastomal and ventral hernias constituted 21% of the surgical practice followed by cholecystectomy (with/ without intraoperative cholangiogram) which comprised 10% of cases. Other common indications for consultation that were less than 10% of the practice included excisional lymph node biopsies for disease diagnosis, splenectomy, skin and soft tissue excisions and feeding tube access.
Conclusion:
Acute care general surgeons play a unique role at dedicated cancer centers by providing surgical expertise for cancer patients during their diagnosis, treatment, and survivorship period. This study demonstrates the service viability and increased efficiency of general surgeon integration into a free-standing cancer center.