Acute Care Surgery Consultation for Abdominal Complaints are Associated with High Mortality in Bone Marrow Transplant Patients

Melissa Coleman, Brigham and Women's Hospital; Philippe Armand, Dana-Farber Cancer Institute; Natasha Coleman, Brigham and Women's Hospital; Zara Cooper, Brigham and Women's Hospital; Joaquim Havens, Brigham and Women's Hospital; Ali Salim, Brigham and Women's Hospital; Reza Askari, Brigham and Women's Hospital

The use of bone marrow transplant for the treatment of patients with hematologic malignancies continues to increase in frequency. Our aim was to better understand the complications of bone marrow transplant which lead to Acute Care Surgery (ACS) consultations. Improvements in the understanding of complications requiring ACS consultation can be used to inform management decisions.

We hypothesized that ACS consultation is associated with high mortality for bone marrow transplant patients.

A retrospective review of the medical records of 1446 patients who underwent bone marrow transplant at the Dana-Farber/Brigham and Women’s Cancer Center from 2006 to 2012 was performed. All instances of ACS consultation which occurred after bone marrow transplant were identified and cataloged.

From 2006 to 2012, 246 ACS consultations were requested for bone marrow transplant patients. Operative interventions were performed for 109 (44%) of these consultations. Abdominal complaints were the most common reasons for consultation, leading to 168 (68%) consults, with a median time of 10 months between the time of bone marrow transplant and consultation. Twenty-one percent of patients died within 30 days of ACS consultation for an abdominal complaint. Of those consults for abdominal complaints, 69 (41%) had surgery with an associated 30-day mortality of 7%.

This retrospective review of ACS consultations in bone marrow transplant patients is the largest reported to date. We found that ACS consultations for abdominal complaints are associated with a high mortality for bone marrow transplant patients. Further analysis is needed to identify the factors contributing to this high mortality. Continued research will improve our understanding of the indications and the outcomes associated with ACS consultations for bone marrow transplant patients.