Mortality In Colorectal Cancer Surgery Research Articles

Impact of preoperative body mass index and weight loss on morbidity and mortality following colorectal cancer—a retrospective cohort study

PurposeBody weight and preoperative weight loss (WL) are controversially discussed as risk factors for postoperative morbidity and mortality in colorectal cancer surgery. The objective of this study is to determine whether body mass index (BMI) or WL is associated with a higher postoperative complication rate.MethodsIn this retrospective cohort study, data analysis of 1241 consecutive patients undergoing colorectal cancer surgery in an 11-year period was performed. The main outcome measures were wound infections (WI), anastomotic leakages (AL), and in-house mortality.ResultsA total of 697 (56%) patients with colon and 544 (44%) with rectum carcinoma underwent surgery. The rate of WI for each location increased with rising BMI. The threshold value was 28.8 kg/m2. Obese patients developed significantly more WI than normal-weight patients did following rectal resection (18.0% vs. 8.2%, p = 0.018). Patients with preoperative WL developed significantly more AL following colon resections than did patients without preoperative WL (6.2% vs. 2.5%, p = 0.046). In-house mortality was significantly higher in obese patients following colon resections than in overweight patients (4.3% vs. 0.4%, p = 0.012). Regression analysis with reference to postoperative in-house mortality revealed neither increased BMI nor WL as an independent risk factor.ConclusionsIncreased preoperative BMI is associated with a higher WI rate. AL rate after colon resection was significantly higher in patients showing preoperative WL. Preoperative BMI and WL are therefore risk factors for postoperative morbidity in this study. Nevertheless, this has to be further clarified by means of prospective studies.Trial registration DRKS00025359, 21.05.2021, retrospectively registered.

Annual hospital volume and colorectal cancer survival in a population-based nationwide cohort study in Finland

PurposeTo examine the annual hospital volume of surgery in relation to survival in colorectal cancer. Previous studies on hospital volume and survival following colorectal cancer surgery are conflicting. MethodsAll 49 032 patients who underwent resection for colorectal cancer in 1987–2016 in Finland were included, with complete follow-up until December 31, 2019. Primary outcome was 5-year mortality. Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI) for quartiles of annual hospital volume for colorectal surgery, adjusted for calendar period, age, sex, comorbidity, stage, tumor location and oncological therapy. Additionally, colon and rectal cancer surgery were assessed separately. Sensitivity analysis of patients with confirmed curative intent was conducted. ResultsCompared to highest quartile (≥108 resections annually), lowest hospital volume (≤37 resections annually) was associated with slightly increased 5-year all-cause mortality (adjusted HR 1.07, 95% CI 1.02–1.12). A pre-planned subgroup-analysis suggested a slightly improved 5-year survival in high-volume institutions for rectal cancer, but not colon cancer surgery. Sensitivity analysis including only those operated with confirmed curative intent suggested no differences between hospital volume groups in colorectal, colon or rectal cancer for 5-year all-cause mortality. ConclusionHigher hospital volume is associated with slightly improved all-cause 5-year mortality in colorectal cancer surgery, but this effect may be limited to rectal cancer surgery only. Volume-outcome relationship in rectal cancer surgery should be investigated further using large datasets. These results do not support centralization of colon cancer surgery based on hospital volume only.

Predictive Model of the Risk of In-Hospital Mortality in Colorectal Cancer Surgery, Based on the Minimum Basic Data Set.

Background: Various models have been proposed to predict mortality rates for hospital patients undergoing colorectal cancer surgery. However, none have been developed in Spain using clinical administrative databases and none are based exclusively on the variables available upon admission. Our study aim is to detect factors associated with in-hospital mortality in patients undergoing surgery for colorectal cancer and, on this basis, to generate a predictive mortality score. Methods: A population cohort for analysis was obtained as all hospital admissions for colorectal cancer during the period 2008–2014, according to the Spanish Minimum Basic Data Set. The main measure was actual and expected mortality after the application of the considered mathematical model. A logistic regression model and a mortality score were created, and internal validation was performed. Results: 115,841 hospitalization episodes were studied. Of these, 80% were included in the training set. The variables associated with in-hospital mortality were age (OR: 1.06, 95%CI: 1.05–1.06), urgent admission (OR: 4.68, 95% CI: 4.36–5.02), pulmonary disease (OR: 1.43, 95%CI: 1.28–1.60), stroke (OR: 1.87, 95%CI: 1.53–2.29) and renal insufficiency (OR: 7.26, 95%CI: 6.65–7.94). The level of discrimination (area under the curve) was 0.83. Conclusions: This mortality model is the first to be based on administrative clinical databases and hospitalization episodes. The model achieves a moderate–high level of discrimination.

Clinical News.

British Journal of Hospital MedicineVol. 79, No. 6 Clinical NewsClinical NewsOlof Dahlqvist, Johann Motsch, Sue Lyon, Jan van der MeulenOlof DahlqvistSearch for more papers by this author, Johann MotschSearch for more papers by this author, Sue LyonSearch for more papers by this author, Jan van der MeulenSearch for more papers by this authorOlof Dahlqvist; Johann Motsch; Sue Lyon; Jan van der MeulenPublished Online:12 Jun 2018https://doi.org/10.12968/hmed.2018.79.6.308AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Linge J, Borga M, West J et al.. Body composition profiling in the UK Biobank Imaging Study. Obesity 2018; https://doi.org/https://doi.org/10.1002/oby.22210 Crossref, Medline, Google ScholarSchuster C, Mayer FJ, Wohlfahrt C et al.. Acute HIV infection results in subclinical inflammatory cardiomyopathy. J Infect Dis. 2018. https://doi.org/https://doi.org/10.1093/infdis/jiy183 Crossref, Medline, Google ScholarFiranescu CE, de Vries J, Lodder P et al.. Vertebroplasty versus sham procedure for painful acute osteoporotic vertebral compression fractures (VERTOS IV): randomised sham controlled clinical trial. BMJ. 2018 May 9;361:k1551. https://doi.org/https://doi.org/10.1136/bmj.k1551 Medline, Google ScholarChapman JL, Cayanan EA, Hoyos CM et al.. Does armodafinil improve driving task performance and weight loss in sleep apnea? A randomized trial. Am J Respir Crit Care Med. 2018 May 18. https://doi.org/https://doi.org/10.1164/rccm.201712-2439OC Crossref, Google ScholarMaria Mavroul M, Vrioni G, Tsakris A et al.. 2018. Reemergence of West Nile Virus infections in humans in Southern Greece, July to September 2017. Abstract P0550 Google ScholarMotsch J, de Oliveira C, Stus V et al.. 2018. RESTORE-IMI 1: a multicentre, randomised, double-blind, comparator-controlled trial comparing the efficacy and safety of imipenem/relebactam versus colistin plus imipenem in patients with imipenem-non-susceptible bacterial infections. Abstract O0427 Google ScholarRobesyn E, Nakitanda OA, Sdona E et al.. 2018. How does the outcome of measles cases under one year of age differ from that of older cases, EU/EEA 2013-2017. Abstract O0060 Google ScholarVallance AE, Fearnhead NS, Kuryba A et al.. Effect of public reporting of surgeons' outcomes on patient selection, “gaming,” and mortality in colorectal cancer surgery in England: population based cohort study. BMJ. 2018;361:k1581. https://doi.org/https://doi.org/10.1136/bmj.k1581 Medline, Google ScholarGilbert T, Neuburger J, Kraindler J et al.. Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. Lancet. 2018;391(10132):1775–1782. https://doi.org/https://doi.org/10.1016/S0140-6736(18)30668-8 Crossref, Medline, Google ScholarYoung AM, Marshall A, Thirlwall J et al.. Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol. 2018 May 10:JCO2018788034. https://doi.org/https://doi.org/10.1200/JCO.2018.78.8034 Medline, Google Scholar FiguresReferencesRelatedDetails 2 June 2018Volume 79Issue 6ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 12 June 2018 Published in print 2 June 2018 Information© MA Healthcare LimitedPDF download

Effect of public reporting of surgeons’ outcomes on patient selection, “gaming,” and mortality in colorectal cancer surgery in England: population based cohort study

ObjectiveTo determine the effect of surgeon specific outcome reporting in colorectal cancer surgery on risk averse clinical practice, “gaming” of clinical data, and 90 day postoperative mortality.DesignNational cohort study.SettingEnglish National...

Anastomotic Leakage and Mortality in Colorectal Cancer Surgery in Octogenarians and Nonagenarians

Anastomotic Leakage and Mortality in Colorectal Cancer Surgery in Octogenarians and Nonagenarians

115. Most important factors to achieve the best hospital performance on serious complications, ‘failure to rescue’ and postoperative mortality in colorectal cancer surgery

115. Most important factors to achieve the best hospital performance on serious complications, ‘failure to rescue’ and postoperative mortality in colorectal cancer surgery

Colorectal cancer surgery for obese patients: Financial and clinical outcomes of a Dutch population-based registry.

The objective of this study was to explore the association among adverse events, body mass index (BMI), and hospital costs after colorectal cancer surgery in a country with an intermediate BMI distribution. All colorectal cancer procedures in 29 Dutch hospitals listed in a 2010-2012 population-based database and with a BMI > 18.5 were included (n = 8687). Hospital costs were measured uniformly and based on time-driven activity-based costing. The BMI classification of the World Health Organization was used. Patients in obesity classes 1 (23.6% [after risk-adjustment OR 1.245, CI 1.064-1.479, P = 0.007]) and ≥2 (28.1% [after risk-adjustment OR 1.816, CI 1.382-2.388, P < 0.001]) were associated with more severe complications and higher hospital costs (€14,294, +9.6%, after risk-adjustment +7.9%, P < 0.001; and €15,913 +22.0%, after risk-adjustment +21.2%, P < 0.001, respectively) than normal weight patients (20.8% and €13,040, respectively). Pre-obese patients had significantly lower mortality rates (2.7%, after risk-adjustment, OR 0.756, CI 0.577-0.991, P = 0.042) than normal-weight patients (3.9%). Obese surgical colorectal cancer patients in a country with an intermediate BMI distribution are associated with a significant increase in hospital costs because these patients suffer from more severe complications. This is the first study to provide evidence for the "obesity-paradox" for mortality in colorectal cancer surgery. J. Surg. Oncol. 2016;113:489-495. © 2016 Wiley Periodicals, Inc.

98. The effect of minimal invasive surgery on postoperative mortality in colorectal cancer surgery

98. The effect of minimal invasive surgery on postoperative mortality in colorectal cancer surgery

433 Predicting Post-Operative Mortality in Colorectal Cancer Surgery: A Systematic Review of the Accuracy of POSSUM, P-POSSUM and CR-POSSUM

433 Predicting Post-Operative Mortality in Colorectal Cancer Surgery: A Systematic Review of the Accuracy of POSSUM, P-POSSUM and CR-POSSUM