Nina Ommundsen1, Arild Nesbakken2, Torgeir Bruun Wyller3, Eva Skovlund4, Arne Olav Bakka5, Marit Slaaen Jordhøy6, Siri Rostoft3. 1. Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, PO box 4956 Nydalen, 0424, Oslo, Norway. Electronic address: nina.ommundsen@ous-hf.no. 2. Institute of Clinical Medicine, University of Oslo, PO box 1072 Blindern, 0316, Oslo, Norway; Department of Gastrointestinal Surgery, Oslo University Hospital, Ullevaal, 0424 Oslo, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, PO box 4956 Nydalen, 0424, Oslo, Norway. 3. Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, PO box 4956 Nydalen, 0424, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, PO box 1072 Blindern, 0316, Oslo, Norway. 4. Department of Public Health and Nursing, NTNU, 7491, Trondheim, Norway. 5. Institute of Clinical Medicine, University of Oslo, PO box 1072 Blindern, 0316, Oslo, Norway; Department of Digestive Surgery, Akershus University Hospital, 1478, Lørenskog, Norway. 6. Institute of Clinical Medicine, University of Oslo, PO box 1072 Blindern, 0316, Oslo, Norway; The Cancer Unit, Innlandet Hospital Trust, 2300, Hamar, Norway.
Abstract
BACKGROUND: The incidence of postoperative complications after colorectal cancer surgery varies between publications. Complications occurring after discharge from hospital are often not reported. The aims of this study were to investigate the proportion of frail older colorectal cancer patients who developed complications only after discharge, the severity of post-discharge complications, and the time point at which the most frequent complications occurred. METHODS: Patients were included if they were 65 years and older, screened positively for frailty and were scheduled for colorectal cancer surgery. Included patients were followed prospectively both in hospital and after discharge for 30 days after surgery, and complications were graded according to the Clavien-Dindo classification. RESULTS: We included 114 patients. Median age was 79 years. Twenty-two patients (19%) were discharged without complications, but developed complications after discharge. These patients had shorter length of stay (6.5 versus 10 days), were more often discharged to their own home without assistance, and had higher 5-year survival (76% vs 54%) than patients who developed complications in hospital. Post-discharge complications were most frequently grade II. The most common types of complications that occurred late in the postoperative course were urinary tract infections and superficial surgical site infections. CONCLUSIONS: Complications after colorectal cancer surgery in frail older patients frequently arise after discharge from hospital. Doctors should be aware of this and inform their patients. This is increasingly important as length of stay after surgery decreases. When complications are used as a quality measure, it should be clear whether only in-hospital complications are registered.
BACKGROUND: The incidence of postoperative complications after colorectal cancer surgery varies between publications. Complications occurring after discharge from hospital are often not reported. The aims of this study were to investigate the proportion of frail older colorectal cancerpatients who developed complications only after discharge, the severity of post-discharge complications, and the time point at which the most frequent complications occurred. METHODS:Patients were included if they were 65 years and older, screened positively for frailty and were scheduled for colorectal cancer surgery. Included patients were followed prospectively both in hospital and after discharge for 30 days after surgery, and complications were graded according to the Clavien-Dindo classification. RESULTS: We included 114 patients. Median age was 79 years. Twenty-two patients (19%) were discharged without complications, but developed complications after discharge. These patients had shorter length of stay (6.5 versus 10 days), were more often discharged to their own home without assistance, and had higher 5-year survival (76% vs 54%) than patients who developed complications in hospital. Post-discharge complications were most frequently grade II. The most common types of complications that occurred late in the postoperative course were urinary tract infections and superficial surgical site infections. CONCLUSIONS: Complications after colorectal cancer surgery in frail older patients frequently arise after discharge from hospital. Doctors should be aware of this and inform their patients. This is increasingly important as length of stay after surgery decreases. When complications are used as a quality measure, it should be clear whether only in-hospital complications are registered.
Authors: Leonie T Jonker; Maarten M H Lahr; Maaike H M Oonk; Geertruida H de Bock; Barbara L van Leeuwen Journal: Ann Surg Oncol Date: 2021-02-27 Impact factor: 5.344
Authors: Brian C Brajcich; Meagan L Shallcross; Julie K Johnson; Rachel Hae-Soo Joung; Cassandra B Iroz; Jane L Holl; Karl Y Bilimoria; Ryan P Merkow Journal: J Surg Res Date: 2021-07-23 Impact factor: 2.192