Abstract
Introduction With the increasing prevalence of colorectal cancer (CRC) worldwide, especially in the elderly, and the variability between physiological and chronological age and its impact on functional status, acute symptoms leading to emergent surgery due to colorectal malignancy may lead to increased morbidity and mortality. The aim of this study is to identify the outcome differences of elective vs. emergent open colectomy in patients above 80 years. Methods The National Surgical Quality Improvement Program (NSQIP) database was reviewed from 2010 to 2014 for open colectomy based on CPT codes. Comparison between groups was done based on the clinical context at presentation as elective or emergent surgery. Data were analyzed using SAS. Results Elective colectomies were performed in 8289 (70.8%) vs. emergent colectomies in 3409 (29.1%). Emergent colectomy patients had higher American Society of Anesthesiologists (ASA) preoperative classification III-IV, 1429 (42.0%) and 224 (6.6%), vs. 1238 (14.9%) and 21 (0.2%) in elective colectomy patients (p < 0.0001). Emergent colectomy patients had more comorbidities such as chronic obstructive pulmonary disorder (493 (14.5%) vs. 796 (9.6%)), congestive heart failure (206 (6.0%) vs. 310 (3.8%)), dialysis (106 (3.1%) vs. 56 (0.7%)), and acute renal failure (166 (4.9%) vs. 46 (0.6%)) (p < 0.0001), respectively. Postoperative morbidity and mortality were significantly higher in emergent colectomy (1651 (48.4%) and 872 (25.6%)) vs. elective colectomy (1859 (22.4%) and 567 (6.8%)) (p < 0.0001), respectively. Conclusion Emergent open colectomy in elderly patients carries a higher risk of morbidity and mortality when compared to elective open colectomy with risk factors being higher ASA classification and more comorbidities.
Highlights
With the increasing prevalence of colorectal cancer (CRC) worldwide, especially in the elderly, and the variability between physiological and chronological age and its impact on functional status, acute symptoms leading to emergent surgery due to colorectal malignancy may lead to increased morbidity and mortality. e aim of this study is to identify the outcome differences of elective vs. emergent open colectomy in patients above 80 years
Functional health status, frailty, comorbidities such as cardiorespiratory, metabolic, and renal diseases, and the American Association of Anesthesiologists (ASA) preoperative classification are predictors and independent risk factors for postoperative morbidity and mortality [7,8,9, 12, 16,17,18,19]. e goal of this study is to identify the outcomes of elective vs. emergent open colectomy in patients above the age of 80 years with the primary outcome being 30-day mortality and the secondary outcome being postoperative morbidity
Variables. e following preoperative variables were included in the analysis: age, race, gender, history of diabetes mellitus, current smoking, hypertension, history of chronic obstructive pulmonary disease (COPD), history of congestive heart failure (CHF), body mass index (BMI) and weight loss, American Society of Anesthesiologists (ASA) classification, preoperative blood transfusion, preoperative total bilirubin, white blood count, hematocrit, platelet count, and international normalized ratio (INR) of prothrombin time (PT) values
Summary
With the increasing prevalence of colorectal cancer (CRC) worldwide, especially in the elderly, and the variability between physiological and chronological age and its impact on functional status, acute symptoms leading to emergent surgery due to colorectal malignancy may lead to increased morbidity and mortality. e aim of this study is to identify the outcome differences of elective vs. emergent open colectomy in patients above 80 years. Emergent open colectomy in elderly patients carries a higher risk of morbidity and mortality when compared to elective open colectomy with risk factors being higher ASA classification and more comorbidities. Studies have shown that elderly patients who are not frail and have a good functional health status can be treated for CRC as aggressively as the younger population, while treatment in the elderly with increased frailty and a decrease in functional health status is still controversial [2]. Acute symptoms such as perforation, bleeding, and obstruction will convert an elective surgery
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