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Use of Hematopoietic Stem Cell Transplantation to Assess the Origin of Myelodysplastic Syndrome
Published on: October 3, 2018
Perioperative mortality in patients with myelodysplastic syndrome
Megan E McNally1, Lavina Malhotra, Mark Bloomston
1Division of Surgical Oncology, Department of Surgery, The Ohio State University Medical Center, James Cancer Center and Solove Research Institute, Columbus, OH, USA. Megan.McNally@osumc.edu
Introduction:
Myelodysplastic syndrome (MDS) is a conglomerate of diseases in which bone marrow-derived cells die before or shortly after entering circulation. We sought to define the perioperative mortality in MDS patients.
Methods:
We reviewed our experience of all persons treated for MDS at our institution over the past 15 years. Demographic and survival information were collected, and those who underwent any procedure requiring general anesthesia were defined as the operative subgroup.
Results:
Of 169 patients identified, 39 (23%) were in the operative subgroup. The median survival was 17.8 months. The mortality rate for the operative group was 23% (N = 9) and 30.8% (N = 12) at 30 and 60 days post-procedure. Twenty-three patients (59%) had an urgent/emergent indication for operation, which was associated with higher 60-day mortality (N = 12, 48%) compared to those with elective indications (N = 1, 7%) (P = 0.037, Chi-square). Several other factors (age, gender, International Prognostic Score, MDACC score, and major/minor procedure type) were not associated with perioperative mortality.
Conclusion:
Outcomes in MDS patients are poor with expected survival less than 2 years and high postoperative mortality in the setting of urgent/emergent operations. While maybe not prohibitive, we believe it is an imperative part of the informed consent process particularly for urgent/emergent procedures.
Insights
Patients with myelodysplastic syndrome (MDS) face poor outcomes and high perioperative mortality, especially for urgent procedures. Informed consent is crucial for these high-risk surgeries.
Area of Science:
- Hematology
- Surgical Oncology
- Critical Care Medicine
Background:
- Myelodysplastic syndrome (MDS) is a group of diseases characterized by ineffective blood cell production.
- Patients with MDS often have poor prognoses and reduced survival rates.
Purpose of the Study:
- To determine the perioperative mortality rate in patients diagnosed with myelodysplastic syndrome.
- To identify factors influencing outcomes in MDS patients undergoing surgical procedures.
Main Methods:
- A retrospective review of 169 MDS patients treated over 15 years.
- Identification of an operative subgroup (39 patients) who underwent procedures requiring general anesthesia.
- Collection of demographic, survival, and procedural data.
Main Results:
- The overall median survival for MDS patients was 17.8 months.
- The 30- and 60-day postoperative mortality rates were 23% and 30.8%, respectively.
- Urgent/emergent procedures were associated with significantly higher 60-day mortality (48%) compared to elective procedures (7%).
Conclusions:
- MDS patients have poor outcomes, with survival often less than two years.
- Urgent/emergent operations in MDS patients are associated with high postoperative mortality.
- Informed consent is essential for MDS patients, particularly before urgent/emergent procedures.
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