The impact of comorbidities on post-operative complications following colorectal cancer surgery

Abstract

Background Colorectal cancer surgery is complex and can result in severe post-operative complications. Optimisation of surgical outcomes requires a thorough understanding of the background complexity and comorbid status of patients. Aim The aim of this study is to determine whether certain pre-existing comorbidities are associated with high grade post-operative complications following colorectal cancer surgery. The study also aims to define the prevalence of demographic, comorbid and surgical features in a population undergoing colorectal cancer resection. Method A colorectal cancer database at The Prince Charles Hospital was established to capture detailed information on patient background, comorbidities and clinicopathological features. A single-centre retrospective study was undertaken to assess the effect of comorbidities on post-operative outcomes following colorectal cancer resection. Five hundred and thirty-three patients were reviewed between 2010–2018 to assess if specific comorbidities were associated with higher grade post-operative complications. A Clavien-Dindo grade of three or higher was defined as a high grade complication. Results Fifty-eight percent of all patients had an ASA grade of ASA III or above. The average BMI of patients undergoing resection was 28 ± 6.0. Sixteen percent of all patients experienced a high grade complications. Patients with high grade complications had a higher mean average age compared to patients with low grade or no post-operative complications (74 years vs 70 years, p = 0.01). Univariate analysis revealed patients with atrial fibrillation, COPD, ischaemic heart disease and heart failure had an increased risk of high grade complications. Multivariate analysis revealed pre-existing atrial fibrillation (OR 2.70, 95% CI 1.53–4.89, p <0.01) and COPD (OR 2.02 1.07–3.80, p = 0.029) were independently associated with an increased risk of high grade complications. Conclusion Pre-existing atrial fibrillation and COPD are independent risk factors for high grade complications. Targeted perioperative management is necessary to optimise outcomes.

Use of Machine Learning and Statistical Algorithms to Predict Hospital Length of Stay Following Colorectal Cancer Resection: A South African Pilot Study

“…We found no significant impact of stoma type on prolonging LOS; however, having stoma formation compared to not having stoma formation increases the odds of extending LOS to about 2.5 times. As seen in other published studies, our study also confirms the significance of hypertension, Eastern Cooperative Oncology Group (ECOG) performance, the American Society of Anesthesiologists (ASA) grading assessment, and grade of differentiation on LOS after colorectal surgery (31)(32)(33). Among the demographic features in this study, sex was the only one that significantly influenced prolonged LOS, and this was well described in other studies.…”

Postoperative and long-term survival in relation to life-expectancy after pancreatic surgery in elderly patients (cohort study)

“…The mortality during the first 90 postoperative days due to medical conditions were 61% and 63% of patients in group A and B, respectively. Different clinical parameters have been used to estimate the risk of pancreatic surgery, and here comorbidity comes in as the most important predictor for the postoperative survival [ 18 ]. However, patients who died in the present study did not have an inferior health status compared to those, who passed through the postoperative period.…”

Survival Impact of Chronic Obstructive Pulmonary Disease or Acute Exacerbation on Patients with Rectal Adenocarcinoma Undergoing Curative Resection: A Propensity Score-Matched, Population-Based Cohort Study

“…Our study is the first study to estimate the survival impact of COPD (Figure 1) and its severity (measured as number of hospitalizations) before the diagnosis of rectal adenocarcinoma in patients with rectal adenocarcinoma (Figure 2). The reason for this association may be that COPD, especially severe COPD, can increase the risk of more intolerable cardiotoxicity or treatment-related toxicity, decrease the cancer-treatment completion rate, or cause more major complications after treatment [21][22][23]68,69]. Another possible explanation is that smoking may cause more aggressive rectal adenocarcinoma [2], and active and heavy smoking is more common among COPDAE phenotypes [70].…”

“…Numerous epidemiologic studies have indicated that smoking is the most critical risk factor for chronic obstructive pulmonary disease (COPD) [13][14][15][16][17][18][19]. In addition, regardless of smoking status, COPD is also an independent risk factor for rectal cancer [20] and is also a strong predictor for intensive care unit admission and mortality after CRC surgery [21,22]; this is as preexisting COPD is an independent risk factor for high-grade complications after treatments [23]. Taken together, both COPD and smoking are independent risk factors or prognostic factors for survival in patients with CRC.…”