Kristine S Corkum1, Timothy B Lautz1, Ferdynand N Hebal2, Erin E Rowell3. 1. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 2. Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 3. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. Electronic address: erowell@luriechildrens.org.
Abstract
BACKGROUND: Children with chronic conditions, including cancer, have been shown to have high-intensity end-of-life care. We assessed the frequency and timing of invasive procedures that children with cancer undergo during their terminal hospital admission (THA). METHODS: The Pediatric Health Information System database was queried from 2011 to 2015 for patients ages 1-18 years with a "malignancy" flag who died in the hospital. Patient demographics, admission details, procedures codes, and date of service were extracted. Invasive procedures were categorized into 'major operations' or 'minor procedures'. RESULTS: 2210 children with cancer were identified as having a THA. During the THA, 1423 (64.4%) patients underwent an invasive procedure and 856 (60.1%) of those children underwent three or more procedures. 466 (21.1%) patients underwent a total of 780 major operations. The most common operations were ventriculostomy/ventriculoperitoneal shunt (n = 211), intracranial mass excision (n = 60), bowel resection (n = 56), and exploratory laparotomy/laparoscopy (n = 46). 101 (21.7%) patients who underwent a major operation died within 48 h of surgery. CONCLUSIONS: Children who have cancer and die in the hospital face a large procedural burden prior to their death. This study highlights the need for open, multidisciplinary discussions regarding the necessity of these procedures and for surgeon involvement in complex end-of-life care decisions. TYPE OF STUDY: Retrospective cohort review. LEVEL OF EVIDENCE: Level IV.
BACKGROUND:Children with chronic conditions, including cancer, have been shown to have high-intensity end-of-life care. We assessed the frequency and timing of invasive procedures that children with cancer undergo during their terminal hospital admission (THA). METHODS: The Pediatric Health Information System database was queried from 2011 to 2015 for patients ages 1-18 years with a "malignancy" flag who died in the hospital. Patient demographics, admission details, procedures codes, and date of service were extracted. Invasive procedures were categorized into 'major operations' or 'minor procedures'. RESULTS: 2210 children with cancer were identified as having a THA. During the THA, 1423 (64.4%) patients underwent an invasive procedure and 856 (60.1%) of those children underwent three or more procedures. 466 (21.1%) patients underwent a total of 780 major operations. The most common operations were ventriculostomy/ventriculoperitoneal shunt (n = 211), intracranial mass excision (n = 60), bowel resection (n = 56), and exploratory laparotomy/laparoscopy (n = 46). 101 (21.7%) patients who underwent a major operation died within 48 h of surgery. CONCLUSIONS:Children who have cancer and die in the hospital face a large procedural burden prior to their death. This study highlights the need for open, multidisciplinary discussions regarding the necessity of these procedures and for surgeon involvement in complex end-of-life care decisions. TYPE OF STUDY: Retrospective cohort review. LEVEL OF EVIDENCE: Level IV.
Authors: Luis Enrique Juárez-Villegas; Myriam M Altamirano-Bustamante; Marta M Zapata-Tarrés Journal: Front Oncol Date: 2021-10-15 Impact factor: 6.244