Postoperative mortality risk factors in colorectal cancer: Follow up of a cohort in a specialised unit

Información del artículo

Abstract

Introduction

The treatment of colorectal cancer (CRC) is usually surgical and involves morbidity-mortality. The aim of this study is to quantify the postoperative mortality in our hospital and to determine their risk factors.

Materials and methods

Prospective observational study from 1996 to 2007 included 1017 patients who underwent surgery for CRC in our hospital. Identification of independent risk factors for postoperative mortality by multivariate analysis.

Results

The mean age was 67.8 years. The surgery was elective in 879 (86.5%) and was considered curative in 878 (86.1%). The postoperative mortality was 3.6% (37 patients), 2.5% in the elective surgery, and 10.9% in the urgent.

The independent risk factors identified were: type of surgery (odds ratio for urgent vs elective=2.8), American Society of Anesthesiologists (ASA) grade (odds ratio for ASA III–IV vs I–II=2.4), age (odds ratio for age ≥85 vs ≤74=7.6 and age 75–84 vs ≤74=2.4).

Conclusions

We found a low postoperative mortality, which was mainly associated with age over 75 years, ASA III or IV stages, and urgent surgery.

Keywords:

Colorectal neoplasms

Colorectal cancer

Colorectal surgery

Mortality

Clinícal audit

Standards

Resumen

Introducción

El tratamiento del cancer colorrectal (CCR) es habitualmente quirúrgico y conlleva una morbimortalidad. El objetivo de este estudio es cuantificar la mortalidad postoperatoria en nuestro hospital y determinar sus factores de riesgo.

Material y método

Estudio prospectivo observacional de los 1.017 pacientes operados en nuestro hospital por CCR desde 1996 hasta 2007. Identificación de factores de riesgo independientes de mortalidad postoperatoria mediante estudio multivariante.

Resultados

La edad media era de 67,8 años. La cirugía se programó en 879 pacientes (86,5%) y se consideró curativa en 878 (86,1%). La mortalidad postoperatoria fue del 3,6% (37 pacientes) (el 2,5% en la cirugía programada y el 10,9% en la cirugía urgente). Los factores de riesgo independientes identificados fueron el tipo de cirugía (odds ratio [OR] para urgente versus programada=2,8), el grado de la American Society of Anesthesiologists (ASA) (OR para ASA III–IV versus ASA I–II=2,4) y la edad (OR para edad ≥85 versus ≤74=7,6 y edad 75–84 versus ≤74=2,4).

Conclusiones

Tenemos una baja mortalidad postoperatoria que se asocia principalmente a una edad mayor de 75 años, a los grados ASA III–IV y a la cirugía urgente.

Palabras clave:

Neoplasia colorrectal

Cáncer colorrectal

Cirugía colorrectal

Mortalidad

Auditoría clínica

Estándares

El Texto completo está disponible en PDF

References

[1.]

Ministerio de Sanidad y Consumo. La situación del cáncer en España. 2005. Ministerio de Sanidad y Consumo; Centro de Publicaciones. Madrid (España) [cited Oct 27, 2009]. Available from: http://www.msc.es/ciudadanos/enfLesiones/enfNoTransmisibles/docs/situacioncancer.pdf.

[2.]

P.M. Ruiz López, E. Rodríguez-Cuéllar, J. Alcalde, I. Landa, E. Jaurrieta.

Informe sobre el proyecto nacional para la gestión clínica de procesos asistenciales. Tratamiento quirúrgico del cáncer colorrectal. II. Desarrollo de la vía clínica.

Cir Esp., 74 (2003), pp. 206-220

[3]

National Institute of clínical Excellence. Improving outcomes in colorectal cancer. 2004. NICE. London (Reino Unido) [cited Oct 27, 2009]. Available from: http://guidance.nice.org.uk/CSGCC/Guidance/pdf/English.

[4.]

M. Romero Simó, R. Alós Company, J. Aparicio Urtasun, R. Estevan Estevan, J. García Armengol, E. Grau Cardona, et al.

Resumen de la guía de práctica clínica en el cáncer colorrectal de la Sociedad Valenciana de Cirugía.

Cir Esp, 65 (1999), pp. 326-330

[5.]

Guías clínicas de la Asociación Española de Cirujanos. Cirugía colorrectal,

[6.]

J.B. Semmens, C. Platell, T. Therlfall, C. Holman, J. D’Arcy.

A population-based study of the incidence, mortality and out- comes in patients following surgery for colorectal cancer in Western Australia.

Aust N Z J Surg, 70 (2000), pp. 11-18

Medline

[7.]

American Society of Anesthesiologists: New classification of physical status.

Anesthesiology, 24 (1963), pp. 111

[8.]

AJCC cáncer staging atlas,

[9.]

L. Staib, K.H. Link, A. Blatz, H.G. Beger.

Surgery of colorectal cancer: surgical morbidity and five- and ten-year results in 2400 patients; Monoinstitutional experience.

World J Surg, 26 (2002), pp. 59-66

http://dx.doi.org/10.1007/s00268-001-0182-5 | Medline

[10.]

V.W. Fazio, P.P. Tekkis, F. Remzi, I.C. Lavery.

Assessment of operative risk in colorectal cancer surgery: The Cleveland Clinic Foundation Colorectal Cancer Model.

Dis Colon Rectum, 47 (2004), pp. 2015-2023

http://dx.doi.org/10.1007/s10350-004-0704-y | Medline

[11.]

W.E. Longo, K.S. Virgo, F.E. Johnson, C.A. Oprian, A.M. Vernava, T.P. Wade, et al.

Risk factors for morbidity and mortality after colectomy for colon cancer.

Dis Colon Rectum, 43 (2000), pp. 83-91

Medline

[12.]

K.V. Menon, R. Farouk.

An analysis of the accuracy of P-POSSUM scoring for mortality risk assessment after surgery for color- ectal cancer.

Colorectal Dis, 4 (2002), pp. 197-200

Medline

[13.]

R. Vilallonga Puy, F. Vallribera Valls, E. Espin Bassany, J.L. Sánchez, M. López Cano, R. Lozoya, et al.

Cirugía colorrectal urgente vs electiva. Análisis comparativo de la morbimortalidad.

Cir Esp, 80 (2006), pp. 137

[14.]

A.M. Ferjani, D. Griffin, N. Stallard, L.S. Wong.

A newly devised scoring system for prediction of mortality in opatients with colorectal cancer: A prospective study.

Lancet Oncol, 8 (2007), pp. 317-322

http://dx.doi.org/10.1016/S1470-2045(07)70045-1 | Medline

[15.]

R.A.M. Damhuis, J.C.J. Wereldsma, T. Wiggers.

The influence of age on resection rates and postoperative mortality in 6457 patients with colorectal cancer.

Int J Colorect Dis, 11 (1996), pp. 45-48

[16.]

J. Mella, A. Biffin, A.G. Radcliffe, J.D. Stamatakis, R.J.C. Steele.

Population-based audit of colorectal cancer management in two UK health regions.

Br J Surg, 84 (1997), pp. 1731-1736

Medline

[17.]

P. Glen, M.F. Simpson, L. Donnelly, S. Leonard, A. Macdonald.

Thirty-day mortality from colorectal cancer surgery within a deprived population.

Colorectal Dis, 7 (2005), pp. 193-195

http://dx.doi.org/10.1111/j.1463-1318.2004.00742.x | Medline

[18.]

P.P. Tekkis, J.D. Poloniecki, M.R. Thompson, J.D. Stamatakis.

Operative mortality in colorectal cancer: Prospective national study.

Br Med J, 327 (2003), pp. 1196-1201

[19.]

E. Mitry, A.M. Bouvier, J. Esteve, J. Faivre.

Benefit of operative mortality reduction on colorectal cancer survival.

Br J Surg, 89 (2002), pp. 1557-1562

http://dx.doi.org/10.1046/j.1365-2168.2002.02276.x | Medline

[20.]

T.N. Nickelsen, T. Jørgensen, O. Kronborg.

Thirty-day mortality after surgery for colorectal cancer in Denmark.

Colorectal Dis, 7 (2005), pp. 500-506

http://dx.doi.org/10.1111/j.1463-1318.2005.00793.x | Medline

[21.]

S.K. Wong, A. Kneebone, M. Morgan, C.J. Henderson, A. Morgan, B. Jalaludin.

Surgical management of colorectal cancer in south-western Sydney 1997–2001: A prospective series of 1293 unselected cases from six public hospitals.

ANZ J Surg, 75 (2005), pp. 776-782

http://dx.doi.org/10.1111/j.1445-2197.2005.03522.x | Medline

[22.]

P. Ruiz López, J. Alcalde Escribano, E. Rodríguez-Cuéllar, I. Landa García, E. Jaurrieta Mata.

Proyecto nacional para la gestión clínica de procesos asistenciales. Tratamiento quirúrgico del cáncer colorrectal. I. Aspectos generales.

Cir Esp, 71 (2002), pp. 173-180

[23.]

A. Alves, Y. Panis, P. Mathieu, G. Mantion, F. Kwiatkowski, K. Slim, et al.

Postoperative mortality and morbidity in French patients undergoing colorectal surgery. Results of a prospective multicenter study.

Arch Surg, 140 (2005), pp. 278-283

http://dx.doi.org/10.1001/archsurg.140.3.278 | Medline

[24.]

P.P. Tekkis, N. Kessaris, H.M. Kocher, J.D. Poloniecki, J. Lyttle, A.C.J. Windsor.

Evaluation of POSSUM and P-POSSUM scoring systems in patients undergoing colorectal surgery.

Br J Surg., 90 (2003), pp. 340-345

http://dx.doi.org/10.1002/bjs.4037 | Medline

[25.]

C.Y. Ko, J.T. Chang, S. Chaudhry, G. Kominski.

Are high-volume surgeons and hospitals the most important predictors of inhospital outcome for colon cancer resection.

Surgery, 132 (2002), pp. 268-273

Medline

[26.]

A. Codina-Cazador, E. Espin, S. Biondo, J. Luján, M. de Miguel, R. Alós, et al.

Proceso docente auditado del tratamiento del cáncer de recto en España: resultados del primer año.

Cir Esp, 82 (2007), pp. 209-213

Medline

[27.]

P.P. Tekkis, D.R. Prytherrch, H.M. Kocher, A. Senapati, J.D. Poloniecki, J.D. Stamatakis, et al.

Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM).

Br J Surg, 91 (2004), pp. 1174-1182

http://dx.doi.org/10.1002/bjs.4430 | Medline

[28.]

A.G. Heriot, P.P. Tekkis, J.J. Smith, C.R.G. Cohen, A. Montgomery, R.A. Audisio, et al.

Prediction of postoperative mortality in elderly patients with colorectal cancer.

Dis Colon Rectum, 49 (2006), pp. 816-824

http://dx.doi.org/10.1007/s10350-006-0523-4 | Medline

[29.]

R. Pla, J.M.V. Pons, J.R. González, J.M. Borrás.

¿Influye en el proceso y en los resultados el volumen de procedimientos en la cirugía del cáncer? Análisis basado en datos clínicoadministrativos.

Cir Esp, 75 (2004), pp. 179-188

[30.]

S.O. Rogers, R.E. Wolf, A.M. Zaslavsky, W.E. Wright, J.Z. Ayanian.

Relation of surgeon and hospital volume to processes and outcomes of colorectal cancer surgery.

Ann Surg, 244 (2006), pp. 1003-1011

http://dx.doi.org/10.1097/01.sla.0000231759.10432.a7 | Medline

[31.]

L.H. Iversen, H. Harling, S. Laurberg, P. Wille-Jorgensen.

Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: A review of evidence. Part I: Short-term outcome.

Colorectal Dis, 7 (2007), pp. 28-37

Indexada en:

Síguenos:

Suscribirse:

Indexada en:

Síguenos:

Suscribirse:

Suscríbase a la newsletter