Abstract
Comorbidities have considerable effects on survival outcomes. The primary objective of this retrospective study was to examine the association between age-adjusted Charlson comorbidity index (ACCI) score and postoperative in-hospital mortality in patients with digestive system cancer who have undergone surgical resection of their cancers. Using electronic hospitalization summary reports, we identified 315,464 patients who had undergone surgery for digestive system cancer in top-rank (Grade 3A) hospitals in China between 2013 and 2015. The Cox proportional hazard regression model was applied to evaluate the effect of ACCI score on postoperative mortality, with adjustments for sex, type of resection, anesthesia methods, and caseload of each healthcare institution. The postoperative in-hospital mortality rate in the study cohort was 1.2% (3,631/315,464). ACCI score had a positive graded association with the risk of postoperative in-hospital mortality for all cancer subtypes. The adjusted HRs for postoperative in-hospital mortality scores ≥ 6 for esophagus, stomach, colorectum, pancreas, and liver and gallbladder cancer were 2.05 (95% CI: 1.45–2.92), 2.00 (95% CI: 1.60–2.49), 2.54 (95% CI: 2.02–3.21), 2.58 (95% CI: 1.68–3.97), and 4.57 (95% CI: 3.37–6.20), respectively, compared to scores of 0–1. These findings suggested that a high ACCI score is an independent predictor of postoperative in-hospital mortality in Chinese patients with digestive system cancer who have undergone surgical resection.
Highlights
Digestive system cancer, including those in the digestive tract and accessory organs, has the highest incidence and mortality of all cancers
A trend toward increased postoperative in-hospital mortality rate with higher ageadjusted Charlson comorbidity index (ACCI) score was consistently noted for all cancer subtypes
In this study of data obtained from a national database in China on over 300,000 resection surgeries for digestive system cancer between 2013 and 2015, age and medical comorbidities as measured by ACCI scores had considerable impacts on the risk of postoperative in-hospital mortality
Summary
Digestive system cancer, including those in the digestive tract and accessory organs, has the highest incidence and mortality of all cancers. In the USA, an estimated 310,440 new cases and 157,700 deaths from digestive system cancer are expected to occur in 2017 [1]. Despite advances in screening programs and chemoradiation treatment over the last few decades, surgical resection remains the mainstay of curative treatment for patients presenting with digestive system cancer. It has been estimated that more than 250,000 patients undergo major cancer surgery in the USA annually [3]. Despite a steady decline attributable to continuous improvements in perioperative care, service and management ability and surgical techniques, postoperative mortality remains one of the most feared postoperative complications. A prospective multicenter www.impactjournals.com/oncotarget cohort study across 28 European nations reported that inhospital postoperative mortality rate was as high as 4% [7]. Preoperative stratification of patients has important clinical implications in individual decision-making, treatment selection, and postoperative care
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