Postoperative Morbidity and Mortality among Veterans Health Administration Patients Undergoing Surgical Resection for Large Bowel Polyps (Bowel Resection for Polyps)

Abstract

Background: Large bowel polyps with malignant characteristics or those that are too large to remove colonoscopically may require bowel resection. Method: We performed a retrospective review of 126 Veterans Health Administration patients who underwent elective resections for colonoscopically unresectable colorectal polyps over a 10-year period. We evaluated the association of patient characteristics and operative management on the composite outcome of 30-day postoperative morbidity and mortality. Results: 98% of patients were males. Mean age was 65.1 years. Most patients had comorbidities, including cardiac or vascular disease (47.4%), diabetes mellitus (54%), and tobacco (41%) or alcohol (32.5%) use. The majority (85.7%) of patients were considered to be in American Society of Anesthesiologists (ASA) physical status classifications III and IV. 92% of resections were completed via laparotomy. Thirty-day postoperative morbidity and mortality occurred among 40 (31.7%) patients. Fifty-six patients (44.4%) had operative specimens with malignant features. The only comorbidity statistically associated with 30-day morbidity and mortality was body mass index >30. Conclusion: Approximately one third of patients had significant postoperative morbidity or mortality. Clinical pathways chosen to treat colonoscopically unresectable polyps should be tailored to patients' conditions and the characteristics of their colorectal lesions.

Morbidity and mortality after surgery for nonmalignant colorectal polyps

“…Mortality in our cohort was generally similar to one study, 15 markedly lower compared with another series, 14 and substantially lower than estimated by scoring systems designed to predict operative mortality. 13 The risk of major morbidity (15%) in our cohort was similar to most prior estimates 9, 15 and lower than 2 small series.…”

“…Surgical resection can be complicated by the need for an ostomy, postoperative infection, wound dehiscence, readmission, reoperation and death. Prior estimates of these risks have included hypothetical models, 13 small numbers of cases, 7, 14, 15 or limited detail on morbidity with no mortality estimates. 9 Understanding the risks associated with surgical resection is necessary to make an informed decision whether to pursue surgery versus endoscopic resection.…”

Morbidity and Mortality After Surgery for Nonmalignant Colorectal Polyps: A 10-Year Nationwide Analysis

“…Therefore, our mortality and morbidity estimates are more generalizable, particularly in non-NSQIP participating US institutions. In cohort-based studies, similarly high risks of postoperative adverse events have also been reported at 20%–30%, although these estimates are limited by sample size considerations (14,23).…”

Malignancy in Large Colorectal Lesions

“…Studies have shown a strong correlation between lesion size and its potential for malignancy (2,4,32) , and these lesions are considered to be at higher risk for submucosal invasion and lymph node involvement (9) . A greater malignant potential for lesions >10 mm (P<0.0001) was observed by Reinhart et al (23) , regardless of morphology.…”