Does Chemotherapy Prior to Emergency Surgery Affect Patient Outcomes? Examination of 1912 Patients
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- Sullivan, M.C., Roman, S.A. & Sosa, J.A. Ann Surg Oncol (2012) 19: 11. doi:10.1245/s10434-011-1844-7
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Data regarding preoperative chemotherapy as a risk to surgical outcomes are limited. This study examines morbidity and mortality among patients necessitating emergent surgical procedures ≤30 days after chemotherapy.
We identified patients ≥18 years that received chemotherapy ≤30 days before emergency surgery (Chemo) in ACS NSQIP, 2005–2008. Subjects were compared with a control group who underwent similar emergent procedures (matched 1:1 on age and procedure/CPT code). Primary outcomes included 30-day postoperative morbidity and mortality. Log-transformed data, bivariate and multivariate linear and conditional logistic regression were used.
A total of 1912 patients were identified (956/group). Patient demographics were similar. The Chemo group had lower BMI (26.3 vs 28.3, P < .001) and more frequent preoperative lab abnormalities. The number of days from admission to operation was greater in the chemo group (3.6 vs 2.6, P < .001). There was no difference in total operative time, days from operation to death, and total length of inpatient stay. Chemo patients were more likely to receive intraoperative transfusions (26.8 vs 18.7, P < .001; odds ratio [OR]: 1.59). Postoperatively, chemo patients had more major complications (44.0% vs 39.2%, P = .033; OR: 1.2), a greater risk of having ≥1 complication (45.0% vs 40.5%, P = .047; OR: 1.2), and higher mortality (22.4% vs 10.3%, P < .001; OR: 2.53). Multivariate analysis identified 3 variables predictive of mortality (chemotherapy, dyspnea, leukopenia), and 2 associated with a major complication (COPD, prolonged PTT).
Patients having emergent surgery after chemotherapy have more comorbidities and severe disease, which are associated with higher complication rates and mortality. Identifying modifiable parameters prior to surgery may improve postoperative outcomes.