Sohail Ahmed1, Denise Howel2, Samuel Debrah3. 1. Darlington Memorial Hospital, Hollyhurst Road, Darlington DL3-6HX, UK. Electronic address: drahmedsohail@yahoo.com. 2. Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne NE2-4AX, UK. Electronic address: denise.howel@ncl.ac.uk. 3. Darlington Memorial Hospital, Darlington DL3-6HX, UK. Electronic address: sdebrah@aol.com.
Abstract
OBJECTIVES: We investigated factors associated with post-operative mortality rates in those aged ≥60, and in particular, the relative survival of age bands within this group. METHODS: Secondary analysis of a large comprehensive cohort of the elderly treated for colorectal cancer in the North of England during 1998-2003. We investigated seven risk factors associated with 30-day and 6-month post-operative mortality from colorectal surgery. RESULTS: 6083 patients aged ≥60 underwent colorectal cancer surgery. Approximately 8% had died within 30 days of surgery and 17% had died within 6 months. Thirty-day mortality was greater in the elderly (80 years+) compared to the young-old (60-69 years) (adjusted OR: 3.2, 95% CI 2.4 to 4.4). There was neither a significant difference between the proportions offered curative resections across the age-groups, nor was there a significant association between intent of surgery and 30-day mortality. Six-month mortality rose with age, but the association was stronger in those having curative surgery (adjusted OR: 3.8, 95% CI 2.8 to 5.2) than palliative surgery (adjusted OR: 1.5, 95% CI 1.1 to 2.1). Mortality from emergency surgery at 6-months was particularly high in elderly females. CONCLUSIONS: This large population study adds more weight to the findings that age itself is a major risk factor in the outcome of colorectal surgery in elderly and that 30-day mortality underestimates the longer-term outcome in this age group. There was no significant association between radical resections and 30-day mortality in elderly patients compared to the younger age groups; however, a disproportionately higher mortality at 6 months was seen in elderly female patients.
OBJECTIVES: We investigated factors associated with post-operative mortality rates in those aged ≥60, and in particular, the relative survival of age bands within this group. METHODS: Secondary analysis of a large comprehensive cohort of the elderly treated for colorectal cancer in the North of England during 1998-2003. We investigated seven risk factors associated with 30-day and 6-month post-operative mortality from colorectal surgery. RESULTS: 6083 patients aged ≥60 underwent colorectal cancer surgery. Approximately 8% had died within 30 days of surgery and 17% had died within 6 months. Thirty-day mortality was greater in the elderly (80 years+) compared to the young-old (60-69 years) (adjusted OR: 3.2, 95% CI 2.4 to 4.4). There was neither a significant difference between the proportions offered curative resections across the age-groups, nor was there a significant association between intent of surgery and 30-day mortality. Six-month mortality rose with age, but the association was stronger in those having curative surgery (adjusted OR: 3.8, 95% CI 2.8 to 5.2) than palliative surgery (adjusted OR: 1.5, 95% CI 1.1 to 2.1). Mortality from emergency surgery at 6-months was particularly high in elderly females. CONCLUSIONS: This large population study adds more weight to the findings that age itself is a major risk factor in the outcome of colorectal surgery in elderly and that 30-day mortality underestimates the longer-term outcome in this age group. There was no significant association between radical resections and 30-day mortality in elderly patients compared to the younger age groups; however, a disproportionately higher mortality at 6 months was seen in elderly female patients.
Authors: Linda B M Weerink; Christina M Gant; Barbara L van Leeuwen; Geertruida H de Bock; Ewout A Kouwenhoven; Ian F Faneyte Journal: Ann Surg Oncol Date: 2018-09-22 Impact factor: 5.344