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Incidence and Outcomes

Robert S. Krouse, MD; Rebecca A. Nelson, PhD; Betty R. Farrell, PhD,FAAN; Baiba Grube, MD; Gloria Juarez, RN,MSN; Lawrence D. Wagman, MD; David Z. J. Chu, MD

Arch Surg. 2001;136:773-778.

Hypothesis  Surgical intervention in palliative care is common; however, the indications, risks, and outcomes are not well described.

Design  Retrospective review of surgical cases during a 1-year period with a minimum 1-year survival update.

Setting  A National Cancer Institute–designated comprehensive cancer center.

Patients  Patients with a cancer diagnosis undergoing operative procedures.

Main Outcome Measures  Number of palliative surgeries and analysis of length of stay, morbidity, and mortality.

Results  Palliative surgeries comprised 240 (12.5%) of 1915 surgical procedures. There were 170 major and 70 minor procedures. Neurosurgical (46.0%), orthopedic (31.3%), and thoracic (21.5%) surgical procedures were frequently palliative. The most common primary diagnoses were lung, colorectal, breast, and prostate cancers. Length of hospital stay was 12.4 days (range, 0-99 days), with 21.3% of procedures performed on an outpatient basis. The 30-day mortality was 12.2%, with 5 patients dying within 5 days of their procedure. The overall mortality was 23.3% (56/240). Mortality for surgical procedures classified as major was 21.9% (44/170) and 10.0% (7/70) for those classified as minor (Fisher exact test, P<.01).

Conclusions  Significant numbers of palliative procedures are performed at our cancer center. Overall morbidity and mortality were high; however, a significant number of patients had short hospital stays and low morbidity. Palliative surgery should remain an important part of end-of-life care. Patients and their families must be aware of the high risks and understand the clear objectives of these procedures.

From the Southern Arizona Veterans Affairs Health Sciences Center and the University of Arizona (Dr Krouse), the AlleCure Corporation (Dr Nelson), the City of Hope National Medical Center (Drs Ferrell, Wagman, and Chu and Ms Juarez), Tucson; and the John Wayne Cancer Institute (Dr Grube) Santa Monica, Calif.

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