Surgical interventions in cancer patients at the end of life: Experiences at an academic medical center.

Abstract

281 Background: Surgical quality measures look to reduce variation and improve outcomes. Procedure goals can range from cure to symptom improvement. Knowledge of procedures used in this population can inform quality metrics, ensure palliation is included and that metrics do not discourage interventions where benefits are other than traditional measures like mortality. Methods: Clinical and administrative data from 1,343 patients treated at an academic medical center from 2006 to 2013 were obtained. Using CPT codes, procedures were identified. Patients who underwent surgical procedures within 180 days of their death were then evaluated to determine the demographic, clinical and surgical characteristics of these cases. Patients <18 years of age and those with missing data were excluded from the analysis. Descriptive statistics were used to describe interventions among patients in the cohort. Results: From 2006 to 2010, 761 patients with cancer treated at an academic medical center had surgical procedures performed within the last 180 days of life. 38.8% of these patients were female, 82% were Caucasian, 15% were African-American, and 3% were other race. Median age was 67.9 years (interquartile range: 58.1 - 78.1). 158 had procedures performed ≤30 days of death, 295 ≤60 days of death, and 530 ≤120 days of death. The most frequent type of procedure performed ≤30 days from death were thoracic procedures including bronchoscopy, thoracentesis, mediastinoscopy and catheter placement for pleural fluid drainage (20.8%), ≤60 days of death 30.3% underwent thoracic procedures, and ≤120 days of death 24.5% underwent similar thoracic procedures. Conclusions: Surgical quality measures are thought to improve surgical outcomes. Evaluation of surgical data from a academic medical center demonstrates continued use interventional procedures in cancer patients within the last 6 months of life. This may in part be due to the symptom burden associated with these diseases. Further evaluation about the goals of interventional procedures in this patient population can inform the outcomes of primary interest in this population of patients who have high mortality due to their advanced disease.