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Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients
BACKGROUND: The frailty of the very elderly patients who undergo surgery for colorectal cancer negatively influences postoperative mortality. This study aimed to identify risk factors for postoperative mortality in octogenarian and nonagenarian patients who underwent surgical treatment for colorecta...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6716468/ https://www.ncbi.nlm.nih.gov/pubmed/31485540 http://dx.doi.org/10.1016/j.heliyon.2019.e02363 |
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author | Novello, Matteo Mandarino, Francesco Vito Di Saverio, Salomone Gori, Davide Lugaresi, Marialuisa Duchi, Alessandro Argento, Francesca Cavallari, Giuseppe Wheeler, James Nardo, Bruno |
author_facet | Novello, Matteo Mandarino, Francesco Vito Di Saverio, Salomone Gori, Davide Lugaresi, Marialuisa Duchi, Alessandro Argento, Francesca Cavallari, Giuseppe Wheeler, James Nardo, Bruno |
author_sort | Novello, Matteo |
collection | PubMed |
description | BACKGROUND: The frailty of the very elderly patients who undergo surgery for colorectal cancer negatively influences postoperative mortality. This study aimed to identify risk factors for postoperative mortality in octogenarian and nonagenarian patients who underwent surgical treatment for colorectal cancer. METHODS: This is a single institution retrospective study. The primary outcomes were risk factors for postoperative mortality. The variables of the octogenarians and nonagenarians were compared by using t-test, chi-square test, and Fisher exact test. A multivariate logistic regression analysis was carried out on the combined cohorts. RESULTS: we identified 319 octogenarians and 43 nonagenarians (N = 362) who underwent surgery for colorectal cancer at the Sant’Orsola-Malpighi university hospital in Bologna between 2011 and 2015. The 30-day post-operative mortality was 6% (N = 18) among octogenarians and 21% (N = 9) for the nonagenarians. The groups significantly differed in the type of surgery (elective vs. urgent surgery, p < 0.0001), ASA score (p = 0.0003) and rates of 30-day postoperative mortality (6% vs. 21%, p = 0.0003). In the multivariate analysis ASA > III (OR 2.37, 95% CI [1.43–3.93], p < 0,001), and urgent surgery (OR 2.17, 95% CI [1.17–4.04], p = 0.014) were associated to post-operative mortality. On the contrary, pre-operative albumin≥3.4 g/dL (OR 0.14, 95% CI [0.05–0.52], p = 0.001) was associated with a protective effect on postoperative mortality. CONCLUSIONS: In the very elderly affected by colorectal cancer, preoperative nutritional status and pre-existing comorbidities, rather than age itself, should be considered as selection criteria for surgery. Preoperative improvement of nutritional status and ASA risk assessment may be beneficial for stratification of patients and ultimately for optimizing outcomes. |
format | Online Article Text |
id | pubmed-6716468 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-67164682019-09-04 Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients Novello, Matteo Mandarino, Francesco Vito Di Saverio, Salomone Gori, Davide Lugaresi, Marialuisa Duchi, Alessandro Argento, Francesca Cavallari, Giuseppe Wheeler, James Nardo, Bruno Heliyon Article BACKGROUND: The frailty of the very elderly patients who undergo surgery for colorectal cancer negatively influences postoperative mortality. This study aimed to identify risk factors for postoperative mortality in octogenarian and nonagenarian patients who underwent surgical treatment for colorectal cancer. METHODS: This is a single institution retrospective study. The primary outcomes were risk factors for postoperative mortality. The variables of the octogenarians and nonagenarians were compared by using t-test, chi-square test, and Fisher exact test. A multivariate logistic regression analysis was carried out on the combined cohorts. RESULTS: we identified 319 octogenarians and 43 nonagenarians (N = 362) who underwent surgery for colorectal cancer at the Sant’Orsola-Malpighi university hospital in Bologna between 2011 and 2015. The 30-day post-operative mortality was 6% (N = 18) among octogenarians and 21% (N = 9) for the nonagenarians. The groups significantly differed in the type of surgery (elective vs. urgent surgery, p < 0.0001), ASA score (p = 0.0003) and rates of 30-day postoperative mortality (6% vs. 21%, p = 0.0003). In the multivariate analysis ASA > III (OR 2.37, 95% CI [1.43–3.93], p < 0,001), and urgent surgery (OR 2.17, 95% CI [1.17–4.04], p = 0.014) were associated to post-operative mortality. On the contrary, pre-operative albumin≥3.4 g/dL (OR 0.14, 95% CI [0.05–0.52], p = 0.001) was associated with a protective effect on postoperative mortality. CONCLUSIONS: In the very elderly affected by colorectal cancer, preoperative nutritional status and pre-existing comorbidities, rather than age itself, should be considered as selection criteria for surgery. Preoperative improvement of nutritional status and ASA risk assessment may be beneficial for stratification of patients and ultimately for optimizing outcomes. Elsevier 2019-08-24 /pmc/articles/PMC6716468/ /pubmed/31485540 http://dx.doi.org/10.1016/j.heliyon.2019.e02363 Text en © 2019 Published by Elsevier Ltd. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Article Novello, Matteo Mandarino, Francesco Vito Di Saverio, Salomone Gori, Davide Lugaresi, Marialuisa Duchi, Alessandro Argento, Francesca Cavallari, Giuseppe Wheeler, James Nardo, Bruno Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients |
title | Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients |
title_full | Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients |
title_fullStr | Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients |
title_full_unstemmed | Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients |
title_short | Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients |
title_sort | post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6716468/ https://www.ncbi.nlm.nih.gov/pubmed/31485540 http://dx.doi.org/10.1016/j.heliyon.2019.e02363 |
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