Mortality in emergency surgical oncology

Area of Science:

• Oncology
• Surgical Oncology
• Emergency Medicine

Background:

• Cancer patients frequently experience treatment- or disease-related complications.
• Emergency room (ER) visits by cancer patients necessitate evaluation for surgical consultation.

Purpose of the Study:

• To evaluate the reasons for emergency room (ER) presentation among surgical oncology patients.
• To determine the outcomes of surgical oncology patients presenting to the ER.

Main Methods:

• Retrospective chart review of surgical oncology patients presenting to the UMCG emergency room (ER) between October 1, 2012, and March 31, 2013.
• Analysis of patient demographics, reasons for ER visit, interventions, and mortality rates.

Main Results:

• 200 cancer patients presented to the ER for surgical consultation.
• Complications from cancer treatment (53.5%) were the most common reason for ER visits, followed by symptoms of malignant disease (25.5%).
• Intestinal obstruction was the most frequent specific reason (26.5%), with a significant portion being malignant.
• 30-day mortality for patients with progressive disease was 25.5%, and overall mortality was 62.8%.
• The majority of patients (59.5%) did not undergo surgery post-ER presentation, with a 30-day mortality of 14.3% and overall mortality of 37.8% in this group.
• Most in-hospital deaths within 30 days occurred in patients who did not receive surgery (89.5%).

Conclusions:

• Significant variation in mortality rates exists for cancer patients presenting to the ER for surgical consultation.
• Patients with progressive disease face the highest mortality risks.
• Urgent surgical intervention in the acute setting should be reserved for essential cases with a favorable expected outcome.