Key result
Older age (≥90 years) was a significant independent risk factor for 30-day postoperative complications after major colorectal surgery (HR 4.95; 95% CI 1.69-14.47; P=0.004).
Cohort (n=204)
Hazard Ratio: 4.95 (95% CI 1.69–14.47)
p-value: p=0.004
In patients aged 80 and older undergoing colorectal surgery, older age, higher ASA score, anemia, lower albumin, and combined surgery are significant risk factors for 30-day complications, which in turn predict 1-year mortality.
May warrant enhanced perioperative monitoring in nonagenarians; leaves open prospective validation of risk-reduction strategies.
PURPOSE: To identify the factors affecting 30-day postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians. METHODS: Between 2005 and 2014, a total of 204 consecutive patients aged ≥80 years who underwent major colorectal surgery were included. RESULTS: One hundred patients were male (49%) and 52 patients had American Society of Anesthesiologists (ASA) score ≥3 (25%). Combined surgery was performed in 32 patients (16%). Postoperative complications within 30 days after surgery occurred in 54 patients (26%) and 30-day mortality occurred in five patients (2%). Independent risk factors affecting 30-day postoperative complications were older age (≥90 years, hazard ratio [HR] with 95% confidence interval [CI] =4.95 [1.69-14.47], P=0.004), an ASA score ≥3 (HR with 95% CI =4.19 [1.8-9.74], P=0.001), performance of combined surgery (HR with 95% CI =3.1 [1.13-8.46], P=0.028), lower hemoglobin level (<10 g/dL, HR with 95% CI =7.56 [3.07-18.63], P<0.001), and lower albumin level (<3.4 g/dL, HR with 95% CI =3.72 [1.43-9.69], P=0.007). An ASA score ≥3 (HR with 95% CI =2.72 [1.15-6.46], P=0.023), tumor-node-metastasis (TNM) stage IV (HR with 95% CI =3.47 [1.44-8.39], P=0.006), and occurrence of postoperative complications (HR with 95% CI =4.42 [1.39-14.09], P=0.012) were significant prognostic factors for 1-year mortality. CONCLUSION: Patient-related factors (older age, higher ASA score, presence of anemia, and lower serum albumin) and procedure-related factors (performance of combined surgical procedure) increased postoperative complications. Avoidance of 30-day postoperative complications may decrease 1-year mortality.
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Kim et al. (2016) conducted a cohort in Colorectal cancer (n=204). Older age (≥90 years) vs. Age 80-89 years was evaluated on 30-day postoperative complications (HR 4.95, 95% CI 1.69-14.47, p=0.004). Older age (≥90 years) was a significant independent risk factor for 30-day postoperative complications after major colorectal surgery (HR 4.95; 95% CI 1.69-14.47; P=0.004).
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