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Postoperative complications in individuals aged 70 and over undergoing elective surgery for colorectal cancer
Author(s) -
Fagard K.,
Casaer J.,
Wolthuis A.,
Flamaing J.,
Milisen K.,
Lobelle J.P.,
Wildiers H.,
Kenis C.
Publication year - 2017
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13821
Subject(s) - medicine , ileus , incidence (geometry) , surgery , intensive care unit , medical record , wound dehiscence , colorectal cancer , dehiscence , cancer , physics , optics
Aim This study aims to describe the nature, incidence, severity and outcomes of in‐hospital postoperative complications ( POC s) in older patients undergoing elective surgery for colorectal cancer. Method Patients ≥ 70 years old were identified from a prospectively collected database (2009–2015) focusing on the implementation of geriatric screening and assessment in patients with cancer. Medical and surgical POC s were retrieved retrospectively from the medical records, and the severity of the POC s was graded by the Clavien–Dindo ( CD ) grading system. The following outcomes were analysed comparing patients with and without CD ≥ 2 and CD ≥ 3 POC s: length of stay ( LOS ), transfer to the intensive care unit, 30‐day readmission rates, 30‐day and 1‐year mortality. Results In the 190 patients included, medical POC s (40.5%) were more frequent than surgical POC s (17.9%), and 37.9% experienced CD ≥ 2 POC s. The most common medical POC s were infections (26.8%), transient confusion or altered mental function (12.1%), cardiac arrhythmia (4.7%), and ileus/gastroparesis/prolonged recovery of transit (4.7%). The most common surgical POC s were surgical site infections (12.1%), wound dehiscence/bleeding (4.7%), anastomotic leak (3.7%) and surgical site bleeding (3.7%). The reoperation rate was 7.9%. CD ≥ 2 POC s led to 11 intensive care unit admissions and increased median postoperative LOS by 114% ( P < 0.0001 for both), but did not significantly alter 30‐day readmission and 30‐day and 1‐year mortality rates. CD ≥ 3 POC s increased LOS by 162% ( P < 0.0001) and showed an increased 1‐year mortality ( P = 0.07). Conclusion This study shows that in‐hospital medical and surgical complications after surgery for colorectal cancer in patients ≥ 70 years old are frequent and that complications lead to less favourable outcomes.