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J Palliat Med. 2014 Jan;17(1):37-42. doi: 10.1089/jpm.2013.0235.

The palliative index: predicting outcomes of emergent surgery in patients with cancer.

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  • 11 Department of Surgery, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania.



The role of emergent palliative surgery in the setting of advanced malignancy remains a subject of controversy.


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.


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.


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.


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.

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[Available on 2015/1/1]
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