Postoperative disposition and health services use in elderly patients undergoing colorectal cancer surgery: A population-based study

Abstract

Little is known about the postoperative status and support needs of patients undergoing colorectal cancer operations. The objective of this study was to describe the disposition and resource use of Ontario's elderly population undergoing colorectal cancer operations as well as to identify predictors of outcomes using population-based data. A total of 33,238 patients aged 50 years and older with a diagnosis of colorectal cancer were identified using International Classification of Diseases 9 and 10 codes in the Ontario Cancer Registry linked to procedure codes in the Canadian Institute for Health Information Discharge Abstract Database representing colorectal operations within 6 months of diagnosis from 1997 to 2004. Data on an individual's home-care use were collected from the Ontario Home Care Administrative System. The cohort was divided into the following age groups: 50-64 years, 65-74 years, 75-79 years, and 80 years and older. The primary outcomes assessed were postoperative mortality, length of stay, discharge disposition, need for home care, and readmission within 30 days. Based on univariate and multivariate analyses, patients aged 75-79 years and 80 years and older were more likely to die in hospital (odds ratio 2.84; 95% confidence interval 2.32-3.47 and odds ratio 5.72; 95% confidence interval 4.76-6.88), stay longer in hospital (2.78 [standard error 0.22] and 5.16 [standard error 0.19] days, respectively), not return home (odds ratio 5.62; confidence interval 3.99-7.98 and odds ratio 11.59; confidence interval 8.32-16.13), receive home care (odds ratio 1.44; 95% confidence interval 1.34-1.55 and odds ratio 1.71; 95% confidence interval 1.59-1.83), and be readmitted (odds ratio 1.31; 95% confidence interval 1.19-1.45 and odds ratio 1.59; 95% confidence interval 1.44-1.75) compared with younger individuals. The rate of discharge home for patients aged 80 years and older was more than 78%. Factors predisposing patients older than 75 years to poorer outcomes were higher Charlson comorbidity score, urgent admission, construction of a stoma, and reoperation. Although discharge-related outcomes worsen with age, most elderly patients do well and can return home after a colorectal cancer operation. Elderly patients require more support; therefore, discharge planning should be part of preoperative assessment and discussions.