Acute Care Surgery Consultation for Abdominal Infection is Associated with High Mortality in Bone Marrow Transplant Patients

Author(s):
Melissa Coleman, Brigham and Women’s Hospital; Natasha Coleman, Brigham and Women’s Hospital; Nathan Blecker, Brigham and Women’s Hospital; Manuel Castillo-Angeles, Brigham and Women’s Hospital; Philippe Armand, Brigham and Women’s Hospital; Reza Askari, Brigham & Women’s Hospital

Background:

The use of bone marrow transplant for the treatment of hematologic malignancies is increasing in frequency.  Our aim was to better understand complications of bone marrow transplant (BMT) which lead to Acute Care Surgery (ACS) consultations for abdominal infection.  Improved understanding of these unique complications may better inform management decisions.

Hypothesis:

We hypothesized that ACS consultation for abdominal infection is associated with high mortality for BMT patients.

Methods:

A retrospective review of the medical records of 1822 patients who underwent BMT at the Dana-Farber/Brigham and Women’s Cancer Center from 2006 to 2013 was performed.  All instances of ACS consultation with a focus on consultations for abdominal complaints were identified and cataloged.  Consultations for abdominal infection included appendicitis, cholecystitis, cholangitis, colitis, and diverticulitis.

Results:

A total of 306 ACS consultations were requested.  Abdominal complaints were the most common, resulting in 214 (70%) consults of which 46 (21%) were for abdominal infections. Median time from BMT to consultation for abdominal infection was 7 months.  Of these consults, 17 (37%) led to an operation, the majority of which were cholecystectomies. Overall thirty-day mortality for patients with abdominal infections was 17%; however, there were no deaths within 30 days among patients who underwent surgery.

Conclusions:

Management of abdominal infection after BMT poses a considerable challenge.  Despite concerns for infection in the first 100 days after BMT due to immunosuppression, the majority of consultations for abdominal infection occurred later post-transplant.  ACS consultations for abdominal infections are associated with a high mortality; however, this mortality is not associated with surgical intervention. Continued analysis is needed to identify the factors contributing to this mortality and may help inform decisions regarding surgical intervention.