Key result
Medical causes drive ~47% of in-hospital deaths after colorectal resection, linked to respiratory comorbidities.
Why the study?
Causes of death following colorectal resection remain poorly explored, and few studies have addressed whether early post-operative mortality is predominantly driven by patient medical comorbidities or by factors related to the presenting surgical disease process.
What are the causes of in-hospital death following colorectal resection and what patient characteristics are associated with a medical cause of death?
Observational (n=750)
Yes
What are the causes of in-hospital death following colorectal resection and what patient characteristics are associated with a medical cause of death?
Absolute Event Rate: 47.3% vs 52.7%
Nearly half of in-hospital deaths following colorectal resection are due to medical causes, highlighting the need for multi-disciplinary care to manage underlying co-morbidities.
Medical causes predominate in post-resection deaths and link to respiratory/malignancy comorbidities; supports perioperative optimization but leaves causal impact open for trials.
BACKGROUND: The causes of death following colorectal resection remain poorly explored. Few studies have addressed whether early post-operative mortality is predominantly caused by a patient's medical co-morbidities, or from factors pertaining to the presenting surgical disease process itself. This study analyses data from the Queensland audit of surgical mortality (QASM) to report the causes of in-hospital death following colorectal resection, identifies whether these were due to either medical or surgical factors, and determines the patient characteristics associated with a medical cause of death. METHODS: Through analysis of QASM Surgical Case Forms, the causes of in-hospital death were determined in 750 patients who died in Queensland following colorectal resection between January 2010 and December 2020. Deaths were attributed to a specific medical or surgical cause, with multivariate analysis used to identify independent risk factors associated with a medical cause of death. RESULTS: In total, 395 patients (52.7%) died due to surgical causes and 355 (47.3%) died due to medical causes. Respiratory co-morbidities (OR 1.832, 95% CI: 1.267-2.650), advanced malignancy (OR 1.814, 95% CI: 1.262-2.607), neurological co-morbidities (OR 1.794, 95% CI: 1.168-2.757) and advanced age (OR 1.430, 95% CI: 1.013-2.017) were independent risk factors associated with increased risk of a medical cause of death. CONCLUSION: Even in the absence of complicating surgical factors, a significant number of patients died in hospital following colorectal resection due to their underlying co-morbidities. Multi-disciplinary models of care which allow for the early recognition and treatment of medical complications may reduce post-operative mortality in these patients.
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Mao et al. (2023) conducted an observational in Colorectal resection (n=750). Colorectal resection was evaluated on Proportion of in-hospital deaths due to medical versus surgical causes. Among 750 in-hospital deaths following colorectal resection, 47.3% were due to medical causes, with respiratory co-morbidities (OR 1.832) and advanced malignancy (OR 1.814) as key risk factors.
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