Nonelective Colon Cancer Resections in Elderly Patients: Results from the Dutch Surgical Colorectal Audit

Abstract

Aims: The aim of the study was to assess which factors contribute to postoperative mortality, especially in elderly patients who undergo emergency colon cancer resections, using a nationwide population-based database. Methods: 6,161 patients (1,172 nonelective) who underwent a colon cancer resection in 2010 in the Netherlands were included. Risk factors for postoperative mortality were investigated using a multivariate logistic regression model for different age groups, elective and nonelective patients separately. Results: For both elective and nonelective patients, mortality risk increased with increasing age. For nonelective elderly patients (80+ years), each additional risk factor increased the mortality risk. For a nonelective patient of 80+ years with an American Society of Anesthesiologists score of III+ and a left hemicolectomy or extended resection, postoperative mortality rate was 41% compared with 7% in patients without additional risk factors. Conclusions: For elderly patients with two or more additional risk factors, a nonelective resection should be considered a high-risk procedure with a mortality risk of up to 41%. The results of this study could be used to adequately inform patient and family and should have consequences for composing an operative team.

Colorectal Cancer Surgery in Extreme Elderly Population

“…Comorbidities of patients with CRC were distributed as follows: hypertension 66.3% (63), lipid disorder 22.1% (21), heart disease 28.4% (27), lung factors 16.8% (16), diabetes mellitus 21.1% (20), cerebrovascular disease 10.5% (10), chronic kidney disease 8.4% (8), cognitive disorder 12.6% (12). Except for hypertension (colon cancer 71.6%, rectal cancer 47.6%, p = 0.040) there were no statistically significant differences in distribution of comorbidities between colon and rectal cancer patients.…”

“…As an example of colorectal cancer surgery, we learned that the presence of at least two significant co-morbidities has a substantial effect in patients older than 70 years, resulting in a mortality of 16.2% when compared with 8.6% in a younger cohort [6] [27]. Emergency surgery even added up the risks to 41% in patients aged over 80 years in the Dutch nationwide population-based study [8]. One-year postsurgical mortality was even 51.2% in patients aged 80 years and older in an English cohort, indicating that age was an independent determinant of mortality in risk adjusted regression analyses [9].…”

Level of Digitization in Dutch Hospitals and the Lengths of Stay of Patients with Colorectal Cancer

“…Patient and tumor characteristics adjusted for are: gender, BMI-index, age, ASA classification, primary location of the tumor, pathological T stage, metastasis, perioperative tumor complications, urgency, additional resections for tumor growth and metastasis. Details concerning the use of relevant case-mix factors have been described elsewhere [16, 17]. We repeated the multivariate regression, by additionally adjusting for surgical complications in three stages: a single complication, a complication combined with reoperation and a complication leading to death.…”

How to evaluate quality for Thoracic Lung Cancer Surgery: A ‘’textbook outcome’’

“…This composite measure aimed to measure the overall quality of surgical lung cancer care, as our study focussed on measuring the quality of postoperative care. Kolfschoten et al focused on ""textbook outcome"" for colorectal cancer surgery in the Netherlands [12]. A ""textbook outcome"" rate of 49 percent was found.…”