Perioperative outcomes of emergency and elective colorectal surgery: a bi‐institutional study

Seeto, Alexander H.; Nabi, Hajir; Burstow, Matthew J.; Lancashire, Raymond P.; Grundy, Joshua; Gillespie, Christopher; Nguyen, Khuong B.; Naidu, Sanjeev; Chua, Terence C.

doi:10.1111/ans.18091

Cited by 4 publications

(2 citation statements)

References 12 publications

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“…Although there is a scarcity of literature evaluating the correlation between emergency colorectal resections and postoperative QoL, Seeto et al. [37] demonstrated that emergency colorectal resections were associated with increased minor, but not major, complications and end stoma formation rates. Interestingly, complications and ostomy formation did not impact PCS or MCS scores in either ≤2 or >2 years groups in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, complications and ostomy formation did not impact PCS or MCS scores in either ≤2 or >2 years groups in our study. This suggests that other factors may contribute to the temporary correlation between emergency surgery and poorer physical functioning such as exacerbation of pre‐existing conditions and lack of prehabilitation, particularly for those undergoing extended radical resections [37, 38]. Increasing early detection rates of EOCRC may prevent the number of index emergency operations performed in this cohort.…”

Section: Discussionmentioning

confidence: 99%

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The health‐related quality of life of early‐onset colorectal cancer patients: an Australian cross‐sectional study

Garrett,

Koh,

Solomon

et al. 2024

Colorectal Disease

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AimEarly‐onset colorectal cancer (EOCRC) patients are more likely to have advanced disease and undergo more aggressive treatment modalities. However, current literature investigating the health‐related quality of life (HRQoL) of EOCRC patients is scarce. This study aimed to determine the HRQoL of an Australian cohort of EOCRC patients including a subset who underwent pelvic exenteration (PE) or cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).MethodA cross‐sectional study of EOCRC patients treated at the Royal Prince Alfred Hospital, Sydney Australia was performed. Patients were divided into groups based on the time interval from their index operation: ≤2 years and >2 years. HRQoL was evaluated using the SF‐36v2 questionnaire.ResultsA total of 50 patients were included. For patients ≤2 years from surgery, the median physical component summary (PCS) and mental health component summary (MCS) scores were 53.3 (36.4–58.9) and 47.3 (37.5–55.7). In the >2 years group, the median PCS and MCS scores were 50.6 (43.3–57.7) and 50.2 (39.04–56.2), respectively. Stage I (vs. stage II) disease and emergency (vs. elective) surgery conferred poorer PCS scores in patients ≤2 years from surgery. No other variables impacted PCS or MCS scores in EOCRC patients in either group.ConclusionsHRQoL of EOCRC patients was equivocal to the Australian population. Having an earlier stage of diagnosis and emergency index operation was associated with poorer levels of physical functioning in patients ≤2 years from surgery. However, because of the limitations of this study, these findings require validation in future large‐scale prospective research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The health‐related quality of life of early‐onset colorectal cancer patients: an Australian cross‐sectional study

Garrett,

Koh,

Solomon

et al. 2024

Colorectal Disease

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Timing of readmissions for complications following emergency colectomy: follow-up beyond post-operative day 30 matters

Caminsky,

Moon,

Marinescu

et al. 2024

Surg Endosc

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Background and purpose Emergency colectomies are associated with a higher risk of complications compared to elective ones. A critical assessment of complications occurring beyond post-operative day 30 (POD30) is lacking. This study aimed to assess the readmission rate and factors associated with readmission 6-months following emergency colectomy. Methods A retrospective cohort study of adult patients who underwent emergency colectomy (2010–2018) was performed using the Nationwide Readmissions Database. The cohort was divided into two groups: (i) no readmission and (ii) emergency readmission(s) for complications related to colectomy (defined using ICD-9/10 codes). Readmissions were categorized as either “early” (POD0–30) or “late” (> POD30). Differences between groups were described and multivariable regression controlling for relevant covariates defined a priori were used to identify factors associated with timing of readmission and cost. Results Of 141,481 eligible cases, 13.22% (n = 18,699) were readmitted within 6-months of emergency colectomy for colectomy-related complications, 61.63% of which were “late” readmissions (> POD30). The most common reasons for “late” readmission were for bleeding, gastrointestinal, and infectious complications (20.80%, 25.30%, and 32.75%, respectively). On multiple logistic regression, female gender (OR 1.12; 95%CI 1.04–1.21), open procedures (OR 1.12, 95%CI 1.011–1.24), and sigmoidectomies (OR 1.51, 95%CI 1.39–1.65, relative to right hemicolectomies) were the strongest predictors of “late” readmission. On multiple linear regression, “late” readmissions were associated with a $1717.09 USD (95%CI $1717.05–$1717.12) increased cost compared to “early” readmissions. Discussion The majority of colectomy-related readmissions following emergency colectomy occur beyond POD30 and are associated with cases that are of overall higher morbidity, as well as open sigmoidectomies. Given the associated increased cost of care, mitigation of such readmissions by close follow-up prior to and beyond POD30 is advisable.

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Emergency Resection for Colonic Cancer Has an Independent and Unfavorable Effect on Long-Term Oncologic Outcome

Sandini,

Piccioni,

Badalucco

et al. 2024

J Gastrointest Canc

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Background Long-term outcomes in patients undergoing emergency versus elective resection for colorectal cancer (CRC) remain controversial. This study aims to assess short- and long-term outcomes of emergency versus elective CRC surgery. Methods In this single-center retrospective cohort study, patients undergoing emergency or elective colonic resections for CRC from January 2013 to December 2017 were included. Primary outcome was long-term survival. As secondary outcomes, we sought to analyze potential differences on postoperative morbidity and concerning the oncological standard of surgical resection. The Kaplan-Meier curves and Cox proportional hazard model were used to compare survival between the groups. Results Overall, 225 CRC patients were included. Of these 192 (85.3%) had an elective and 33 (14.7%) an emergency operation. Emergency indications were due to obstruction, perforation, or bleeding. Patients in the emergency group had higher ASA score (p = 0.023), higher Charlsson comorbidity index (CCI, p = 0.012), and were older than those in the elective group, with median age 70 (IQR 63–79) years and 78 (IQR 68–83) years, for elective and emergency, respectively (p = 0.020). No other preoperative differences were observed. Patients in the emergency group experienced significantly more major complications (12.1% vs. 3.6%, p = 0.037), more anastomotic leakage (12.1% vs. 1.6%, p = 0.001), need for reoperation (12.1% vs. 3.1%, p = 0.021), and postoperative mortality (2 patients vs. 0, p < 0.001). No differences in terms of final pathological stage, nor in accuracy of lymphadenectomy were observed. Overall survival was significantly worse in case of emergency operation, with estimated median 41 months vs. not reached in elective cases (p < 0.001). At the multivariate analysis, emergency operation was confirmed as independent unfavorable determinant of survival (with hazard rate HR = 1.97, p = 0.028), together with age (HR = 1.05, p < 0.001), postoperative major morbidity (HR = 3.18, p = 0.012), advanced stage (HR = 5.85, p < 0.001), and need for transfusion (HR = 2.10, p = 0.049). Conclusion Postoperative morbidity and mortality were increased in emergency versus elective CRC resections. Despite no significant differences in terms of accuracy of resection and pathological stages, overall survival was significantly worse in patients who underwent emergency procedure, and independent of other determinants of survival.

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Perioperative outcomes of emergency and elective colorectal surgery: a bi‐institutional study

Cited by 4 publications

References 12 publications

The health‐related quality of life of early‐onset colorectal cancer patients: an Australian cross‐sectional study

The health‐related quality of life of early‐onset colorectal cancer patients: an Australian cross‐sectional study

Timing of readmissions for complications following emergency colectomy: follow-up beyond post-operative day 30 matters

Emergency Resection for Colonic Cancer Has an Independent and Unfavorable Effect on Long-Term Oncologic Outcome

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