What question did this study set out to answer?

To identify preoperative and intraoperative clinical risk factors that predict 30-day morbidity and mortality following proctectomy for rectal cancer.

July 1, 1998Annals of SurgeryOpen Access

Outcome After Proctectomy for Rectal Cancer in Department of Veterans Affairs Hospitals

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Why the study?

What are the risk factors predicting adverse outcomes (30-day morbidity and mortality) after proctectomy for rectal cancer in VA hospitals?

Population

591 patients undergoing proctectomy for rectal cancer from 1991 to 1995 registered in the National VA…

Design

Cohort

Follow-up

30 days

Authors

WLWalter E. LongoMedical College of Wisconsin KVKatherine S. VirgoEmory University FJFrank E. JohnsonNational Sedimentation Laboratory

Discussion

Member takes

Implication

These predictors may aid preoperative risk stratification in rectal cancer surgery; hypothesis-generating pending validation in contemporary non-VA cohorts.

Key Points

To identify preoperative and intraoperative clinical risk factors that predict 30-day morbidity and mortality following proctectomy for rectal cancer.
Analyzed prospectively collected registry data from the National VA Surgical Quality Improvement Program on 591 patients undergoing proctectomy (467 abdominoperineal resections and 124 sphincter-saving procedures) between 1991 and 1995.
Evaluated 68 presurgical and 12 intraoperative risk factors across 21 adverse outcomes using stepwise logistic regression analysis to model 30-day morbidity and mortality.
Postoperative complications occurred in 30% of patients, with prolonged ileus, urinary tract infection, pneumonia, and deep wound infection being the most frequent.
Overall 30-day mortality was 3.2% (19 deaths), but mortality exceeded 50% following severe complications including cardiac arrest, acute renal failure, prolonged coma, stroke, deep venous thrombosis, and pulmonary embolism.
Multivariable logistic regression identified four independent presurgical predictors of 30-day mortality: elevated blood urea nitrogen, impaired sensorium, low serum albumin, and partial thromboplastin time ≤25 seconds.

Structured PICO

What are the risk factors predicting adverse outcomes (30-day morbidity and mortality) after proctectomy for rectal cancer in VA hospitals?

Population

591 patients undergoing proctectomy for rectal cancer from 1991 to 1995 registered in the National VA Surgical Quality Improvement Program database.

Intervention

Proctectomy (abdominoperineal resection or sphincter-saving procedures)

Outcome

30-day morbidity rates for the 10 most common complications and 30-day mortality ratehard clinical

Elevated presurgical BUN, impaired sensorium, low serum albumin, and PTT ≤25 seconds are significant predictors of 30-day mortality after proctectomy for rectal cancer.

Cite This Study

Longo et al. (1998) studied this question.

synapsesocial.com/papers/6a73bd3e1c100ebba7fb6ec3 https://doi.org/10.1097/00000658-199807000-00010

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Implication

These predictors may aid preoperative risk stratification in rectal cancer surgery; hypothesis-generating pending validation in contemporary non-VA cohorts.

Outcome After Proctectomy for Rectal Cancer in Department of Veterans Affairs Hospitals

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Outcome After Proctectomy for Rectal Cancer in Department of Veterans Affairs Hospitals

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider