Myelodysplastic syndrome: An update on diagnosis and therapy

Perioperative mortality in patients with myelodysplastic syndrome

INTRODUCTION

Myelodysplastic syndrome (MDS) is a conglomerate of diseases in which bone marrow-derived cells die before or shortly after entering circulation. We sought to define the perioperative mortality in MDS patients.

METHODS

We reviewed our experience of all persons treated for MDS at our institution over the past 15 years. Demographic and survival information were collected, and those who underwent any procedure requiring general anesthesia were defined as the operative subgroup.

RESULTS

Of 169 patients identified, 39 (23%) were in the operative subgroup. The median survival was 17.8 months. The mortality rate for the operative group was 23% (N = 9) and 30.8% (N = 12) at 30 and 60 days post-procedure. Twenty-three patients (59%) had an urgent/emergent indication for operation, which was associated with higher 60-day mortality (N = 12, 48%) compared to those with elective indications (N = 1, 7%) (P = 0.037, Chi-square). Several other factors (age, gender, International Prognostic Score, MDACC score, and major/minor procedure type) were not associated with perioperative mortality.

CONCLUSION

Outcomes in MDS patients are poor with expected survival less than 2 years and high postoperative mortality in the setting of urgent/emergent operations. While maybe not prohibitive, we believe it is an imperative part of the informed consent process particularly for urgent/emergent procedures.