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 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.