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Congestive heart failure and comorbidity as determinants of colorectal cancer perioperative outcomes

Published: June 11, 2021
Category: Bibliography
Authors: Antonio Corcione, Antonio Crucitti, Concezione Tommasino, Cristina Basso, Elena Schievano, Eliana Ferroni, Fernando Chiumiento, Flavia Petrini, Francesco Avossa, Gabriella Bettelli, Marco Montorsi, Marco Trabucchi, Maria Caterina Pace, Maria Chiara Corti, Marianna Noale, Matilde Dotto, Michele Carron, Nicola Gennaro, Paola Aceto, Raffaele Antonelli Incalzi, Stefania Maggi, Stefano Volpato
Country: Italy
Language: English
Types: Outcomes, Population Health, Surgical Care
Setting: Hospital

Abstract

Objective

There has been an increase in surgical interventions in frailer elderly with concomitant chronic diseases. The purpose of this paper was to evaluate the impact of aging and comorbidities on outcomes in patients who underwent surgery for the treatment of colorectal cancer (CRC) in Veneto Region (Northeastern Italy).

Methods

This is a retrospective cohort study in patients ≥ 40 years who underwent elective or urgent CRC surgical resection between January 2013 and December 2015. Independent variables included: age, sex, and comorbidities. We analyzed variables associated with the surgical procedure, such as stoma creation, hospitalization during the year before the index surgery, the surgical approach used, the American Society of Anesthesiologists (ASA) score, and the Charlson Comorbidity Index score. Eight thousand four hundred and forty-seven patients with CRC underwent surgical resection.

Results

Patient age affected both pre- and post-resection LOS as well as the overall survival (OS); however, it did not affect the 30-day readmission and reoperation rates. Multivariate analysis showed that age represented a risk factor for longer preoperative and postoperative LOS as well as for 30-day and 365-day mortality, but it was not associated with an increased risk of 30-day reoperation and 30-day readmission. Chronic Heart Failure increased the 30-day mortality risk by four times, the preoperative LOS by 51%, and the postoperative LOS by 33%. Chronic renal failure was associated with a 74% higher 30-day readmission rate.

Conclusion

Advanced age and comorbidities require a careful preoperative evaluation and appropriate perioperative management to improve surgical outcomes in older patients undergoing elective or urgent CRC resection.

surgical outcomes,colorectectal cancer,CRC resection,age,comorbidities

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