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. 2014 Jan;17(1):37-42.
doi: 10.1089/jpm.2013.0235.

The palliative index: predicting outcomes of emergent surgery in patients with cancer

Robert E Roses  1 , Ching-Wei D Tzeng, Merrick I Ross, Keith F Fournier, Daniel E Abbott, Y Nancy You
Affiliations

The palliative index: predicting outcomes of emergent surgery in patients with cancer

Robert E Roses et al. J Palliat Med. 2014 Jan.

Abstract

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 albumin <2.8 (p=0.040). Median OS was 5.4 months in patients with AD and was not reached in patients without AD (p<0.001). Independent predictors of decreased OS included AD; ASA >3; 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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Figures

<b>FIG. 1.</b>
FIG. 1.
Overall survival in patients with and without active disease.
<b>FIG. 2.</b>
FIG. 2.
Overall survival stratified by risk score.
See this image and copyright information in PMC

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