Nguyen Matthew, Nahmias Jeffry, Eng Oliver S, Senthil Maheswari, Barrios Cristobal, Dolich Matthew, Lekawa Michael, Grigorian Areg
University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
University of California, Irvine, Department of Surgery, Division of Surgical Oncology, Orange, CA, USA.
Surg Open Sci. 2024 Jul 17;20:184-188. doi: 10.1016/j.sopen.2024.07.005. eCollection 2024 Aug.
There is a paucity of literature guiding trauma surgeons in the care of patients with active metastatic cancer (MC). Even less is known regarding outcomes for MC patients requiring emergent surgery after trauma. We hypothesized that trauma patients with active Metastatic Cancer (MC) have an increased mortality rate and undergo increased rates of withdrawal of care (WoC) within 72-hours following emergent operations, compared to similarly matched patients without MC.
Patients with active MC at the time of traumatic injury were matched 1:2 against patients without active MC based on demographics, comorbidities, vital signs on admission, and injury profile.
From 43,826 patients, 0.2 % had MC. After matching 39 MC patients to 78 without MC, there was no difference in demographics, comorbidities, injury severity score, mechanism of injury, vitals on admission (blood pressure, heart rate, respiration rate) and need for blood transfusion (all > 0.05). Compared to patients without MC, patients with MC had higher rates and associated risk of death during index hospitalization (38.5 % vs. 15.2 %, = 0.005; OR 3.49, CI 1.43-8.51, = 0.006), as well as a higher rate and associated risk of WoC within 72-hours (12.8 % vs. 1.3 %, = 0.007; OR 11.47, CI 1.29-101.93, = 0.029).
Trauma patients with MC requiring emergent thoracic or abdominal surgery have a high risk of death and an over ten-fold higher associated risk for WoC within the first three days. In some cases, palliative care consultation should be considered, and counseling should be offered to this high-risk trauma population to enable individualized and patient-centric decisions.
This research highlights the importance of a multidisciplinary team consisting of trauma surgeons, oncologist, and palliative care physicians in caring for the high-risk trauma patients with disseminated cancer requiring urgent surgery.
指导创伤外科医生治疗活动性转移性癌症（MC）患者的文献较少。对于创伤后需要急诊手术的MC患者的预后了解更少。我们假设，与无MC的匹配患者相比，患有活动性转移性癌症（MC）的创伤患者在急诊手术后72小时内死亡率增加，且护理撤减（WoC）率升高。
根据人口统计学、合并症、入院时生命体征和损伤情况，将创伤时患有活动性MC的患者与无活动性MC的患者按1:2进行匹配。
在43826例患者中，0.2%患有MC。将39例MC患者与78例无MC患者匹配后，在人口统计学、合并症、损伤严重程度评分、损伤机制、入院时生命体征（血压、心率、呼吸频率）和输血需求方面均无差异（均>0.05）。与无MC的患者相比，MC患者在首次住院期间的死亡率更高且相关风险更高（38.5%对15.2%，P=0.005；OR 3.49，CI 1.43 - 8.51，P=0.006），以及在72小时内的WoC率更高且相关风险更高（12.8%对1.3%，P=0.007；OR 11.47，CI 1.29 - 101.93，P=0.029）。
需要急诊胸腹部手术的MC创伤患者死亡风险高，且在前三天内WoC的相关风险高出十倍以上。在某些情况下，应考虑姑息治疗会诊，并为这一高风险创伤人群提供咨询，以做出个性化的、以患者为中心的决策。
本研究强调了由创伤外科医生、肿瘤学家和姑息治疗医生组成的多学科团队在护理需要紧急手术的播散性癌症高风险创伤患者中的重要性。
