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Sljivic S, Nam J, Matthews R, Agala CB, Hollowell J, Nizamani R, King B, Williams FN. Does A History of Malignancy Lead to Worse Outcomes in a Single-center Burn Unit? J Burn Care Res 2023; 44:274-279. [PMID: 36617221 DOI: 10.1093/jbcr/irad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Indexed: 01/09/2023]
Abstract
A history of malignancy is associated with worse outcomes in cardiac disease and trauma. Our objective was to determine if a past medical history or comorbid condition of cancer portends an increased morbidity or mortality in burns or skin-sloughing disorders at our institution. Patients were identified using our Institutional Burn Center registry and linked to the clinical and administrative data. All patients admitted between January 1, 2014 and June 30, 2021 were eligible for inclusion. Demographics, length of stay, comorbid conditions and mortality were evaluated. Statistical analysis was performed with Kruskal-Wallis, chi-square, and Fisher's exact tests. Seven thousand three hundred seventy-two patients were admitted during this time period. Three hundred eighty-six patients had a history of cancer (5%). Patients with a history of cancer were older (56 vs 44 years, P < .0001). They had a significantly longer length of stay (16 vs 10 days, P < .0001). They also had larger burns and higher hospital costs ($147,021 versus $83,788, P < .0001), were more likely to be male and more likely to have a skin-sloughing disorder. A history of cancer was not associated with increased odds of burn mortality. Thus, a history of cancer is associated with increased lengths of stay and costs in patients admitted for burn injury or skin-sloughing disorders, but not associated with increased mortality. Further study is warranted to investigate and mitigate what aspects of their care could be adjusted to improve outcomes.
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Affiliation(s)
- Sanja Sljivic
- Department of Surgery, University of North Carolina School of Medicine, 101 Manning Drive Chapel Hill, North Carolina 27599, USA.,North Carolina Jaycee Burn Center, 101 Manning Drive Chapel Hill, North Carolina 27599, USA
| | - Jason Nam
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Hospital, 2301 Erwin Road Durham, North Carolina 27710, USA
| | - Robert Matthews
- Department of Anesthesiology, University of North Carolina School of Medicine, 101 Manning Drive Chapel Hill, North Carolina 27599, USA
| | - Chris B Agala
- Department of Surgery, University of North Carolina School of Medicine, 101 Manning Drive Chapel Hill, North Carolina 27599, USA
| | - Jamie Hollowell
- Department of Surgery, University of North Carolina School of Medicine, 101 Manning Drive Chapel Hill, North Carolina 27599, USA.,North Carolina Jaycee Burn Center, 101 Manning Drive Chapel Hill, North Carolina 27599, USA
| | - Rabia Nizamani
- Department of Surgery, University of North Carolina School of Medicine, 101 Manning Drive Chapel Hill, North Carolina 27599, USA.,North Carolina Jaycee Burn Center, 101 Manning Drive Chapel Hill, North Carolina 27599, USA
| | - Booker King
- Department of Surgery, University of North Carolina School of Medicine, 101 Manning Drive Chapel Hill, North Carolina 27599, USA.,North Carolina Jaycee Burn Center, 101 Manning Drive Chapel Hill, North Carolina 27599, USA
| | - Felicia N Williams
- Department of Surgery, University of North Carolina School of Medicine, 101 Manning Drive Chapel Hill, North Carolina 27599, USA.,North Carolina Jaycee Burn Center, 101 Manning Drive Chapel Hill, North Carolina 27599, USA
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Barz M, Bette S, Janssen I, Aftahy AK, Huber T, Liesche-Starnecker F, Ryang YM, Wiestler B, Combs SE, Meyer B, Gempt J. Age-adjusted Charlson comorbidity index in recurrent glioblastoma: a new prognostic factor? BMC Neurol 2022; 22:32. [PMID: 35062885 PMCID: PMC8780246 DOI: 10.1186/s12883-021-02532-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/22/2021] [Indexed: 12/27/2022] Open
Abstract
Abstract
Background
For recurrent glioblastoma (GB) patients, several therapy options have been established over the last years such as more aggressive surgery, re-irradiation or chemotherapy. Age and the Karnofsky Performance Status Scale (KPSS) are used to make decisions for these patients as these are established as prognostic factors in the initial diagnosis of GB. This study’s aim was to evaluate preoperative patient comorbidities by using the age-adjusted Charlson Comorbidity Index (ACCI) as a prognostic factor for recurrent GB patients.
Methods
In this retrospective analysis we could include 123 patients with surgery for primary recurrence of GB from January 2007 until December 2016 (43 females, 80 males, mean age 57 years (range 21–80 years)). Preoperative age, sex, ACCI, KPSS and adjuvant treatment regimes were recorded for each patient. Extent of resection (EOR) was recorded as a complete/incomplete resection of the contrast-enhancing tumor part.
Results
Median overall survival (OS) was 9.0 months (95% CI 7.1–10.9 months) after first re-resection. Preoperative KPSS > 80% (P < 0.001) and EOR (P = 0.013) were associated with significantly improved survival in univariate analysis. Including these factors in multivariate analysis, preoperative KPSS < 80 (HR 2.002 [95% CI: 1.246–3.216], P = 0.004) and EOR are the only significant prognostic factor (HR 1.611 [95% CI: 1.036–2.505], P = 0.034). ACCI was not shown as a prognostic factor in univariate and multivariate analyses.
Conclusion
For patients with surgery for recurrent glioblastoma, the ACCI does not add further information about patient’s prognosis besides the well-established KPSS and extent of resection.
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