Chun Hin Angus Lee1,2, Joseph Cherng Huei Kong3, Alexander G Heriot4,3, Satish Warrier4,3, John Zalcberg5, Paul Sitzler4. 1. Epworth Healthcare, Melbourne, VIC, 3121, Australia. angus.lee@petermac.org. 2. Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia. angus.lee@petermac.org. 3. Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia. 4. Epworth Healthcare, Melbourne, VIC, 3121, Australia. 5. Cancer Research Program, School of Public Health & Preventive Medicine, Faculty of Medicine, Monash University, Monash, Melbourne, VIC, 3004, Australia.
Abstract
BACKGROUNDS: A significant number of patients with colorectal cancer will have an emergency presentation requiring surgery. This study aims to evaluate short-term outcomes for patients undergoing emergency colorectal cancer surgery in Australasia. METHODS: All consecutive CRC from the Bi-National Colorectal Cancer Audit Database was interrogated from 2007 to 2016. Short-term outcomes including length of stay, complication rate and mortality rate were compared between the emergency and elective groups. Logistic regression analysis was performed to identify independent predictors for inpatient mortality. A predictive model for inpatient mortality was constructed using these variables, and its accuracy was then validated by the Bootstrap re-sampling method. RESULTS: Of 15,676 colorectal cancer cases identified, 13.6% were emergency cases. The emergency group had a higher rate of surgical and medical complications (26.7% vs 22.6%, p < 0.001; 22.8 vs 13.8%, p < 0.001, respectively). Higher inpatient mortality rate was also observed in the emergency group (3.4% vs 2.6%, p = 0.023). Independent predictors for inpatient survival included age, American Society Anaesthesiologists score, emergency surgery and tumour stage. In addition, postoperative complications such as anastomotic leak (odds ratio [OR] 3.78, p < 0.001), sepsis (OR 2.85, p < 0.001) and medical complications (OR 13.88, p < 0.001) had a significant impact in survival in the emergency group. Receiver operating characteristics curve for inpatient mortality was 0.913. CONCLUSION: Emergency colorectal cancer surgery carries significant morbidity and mortality. Recognition of the increasing rate of postoperative complications may help minimise the detrimental impact of this event on overall outcomes.
BACKGROUNDS: A significant number of patients with colorectal cancer will have an emergency presentation requiring surgery. This study aims to evaluate short-term outcomes for patients undergoing emergency colorectal cancer surgery in Australasia. METHODS: All consecutive CRC from the Bi-National Colorectal Cancer Audit Database was interrogated from 2007 to 2016. Short-term outcomes including length of stay, complication rate and mortality rate were compared between the emergency and elective groups. Logistic regression analysis was performed to identify independent predictors for inpatient mortality. A predictive model for inpatient mortality was constructed using these variables, and its accuracy was then validated by the Bootstrap re-sampling method. RESULTS: Of 15,676 colorectal cancer cases identified, 13.6% were emergency cases. The emergency group had a higher rate of surgical and medical complications (26.7% vs 22.6%, p < 0.001; 22.8 vs 13.8%, p < 0.001, respectively). Higher inpatient mortality rate was also observed in the emergency group (3.4% vs 2.6%, p = 0.023). Independent predictors for inpatient survival included age, American Society Anaesthesiologists score, emergency surgery and tumour stage. In addition, postoperative complications such as anastomotic leak (odds ratio [OR] 3.78, p < 0.001), sepsis (OR 2.85, p < 0.001) and medical complications (OR 13.88, p < 0.001) had a significant impact in survival in the emergency group. Receiver operating characteristics curve for inpatient mortality was 0.913. CONCLUSION:Emergency colorectal cancer surgery carries significant morbidity and mortality. Recognition of the increasing rate of postoperative complications may help minimise the detrimental impact of this event on overall outcomes.
Authors: V Lin; A Tsouchnika; E Allakhverdiiev; A W Rosen; M Gögenur; J S R Clausen; K B Bräuner; J S Walbech; P Rijnbeek; I Drakos; I Gögenur Journal: Tech Coloproctol Date: 2022-05-20 Impact factor: 3.699
Authors: Melissa N N Arron; Nynke G Greijdanus; Sarah Bastiaans; Pauline A J Vissers; Rob H A Verhoeven; Richard P G Ten Broek; Henk M W Verheul; Pieter J Tanis; Harry van Goor; Johannes H W de Wilt Journal: Ann Surg Date: 2022-08-05 Impact factor: 13.787
Authors: Daniëlle D Huijts; Jan Willem T Dekker; Leti van Bodegom-Vos; Julia T van Groningen; Esther Bastiaannet; Perla J Marang-van de Mheen Journal: Int J Qual Health Care Date: 2021-03-11 Impact factor: 2.038