The Palliative Index: Predicting Outcomes of Emergent Surgery in Patients with Cancer


BACKGROUND: The role of emergent palliative surgery in the setting of advanced malignancy remains a subject of controversy.

OBJECTIVE: The purpose of this study was to identify clinical predictors of outcome in patients with cancer who undergo nonelective abdominal surgery.

SETTING/SUBJECTS: Individuals who underwent urgent and emergent abdominal operations between 2006 and 2010 at a tertiary cancer center were identified.

MEASUREMENTS: Analyses were performed to identify predictors of 30-day morbidity and mortality as well as overall survival (OS). A risk score was derived from predictors of OS.

RESULTS: Of 143 patients, 93 (65%) had active disease (AD; defined as evidence of malignancy at time of surgery). Thirty-day morbidity and mortality were 36.4% and 9.8%, respectively. Independent predictors of 30-day mortality included ASA score >3 (p=0.009) and albumin3; creatinine >1.3; and a tumor-related indication (i.e., bleeding, obstructing, or perforating tumor). A risk or palliative index (PI) score stratified patients into groups with discreet outcomes.

CONCLUSIONS: Although AD did not predict 30-day morbidity, it was the dominant independent predictor of postoperative OS. In cancer patients undergoing emergency abdominal surgery, outcome is anticipated by disease status and other independent predictors of OS.

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Notes/Citation Information

Published in Journal of Palliative Medicine, v. 17, issue 1, p. 37-42.

© 2014, Mary Ann Liebert, Inc.

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Funding Information

This work was supported by the University of Texas Cancer Center Core Support Grant (P30CA016672).