Background The proportion of cancer cases in younger patients is increasing though colorectal cancer (CRC) screening guidelines recommend starting at age 50. The national treatment patterns and outcomes of these patients are largely unknown. Methods This is a population-based retrospective cohort study of the nationally representative Surveillance, Epidemiology, and End Results registry for patients diagnosed with CRC from 1998-2011. Patients were categorized as being younger or older than the recommended screening age. Differences in stage at diagnosis, patterns of therapy, and disease-specific survival were compared between age groups using multinomial regression, multiple regression, cox-proportional hazards regression, and Weibull survival analysis. Results Of 258,024 CRC patients, 37,847 (15%) were younger than 50. Young patients were more likely to present with regional (Relative risk ratio [RRR]: 1.3, p<0.001) or distant (RRR: 1.5, p<0.001) disease. CRC patients with distant metastasis were more likely to receive surgical therapy for their primary tumor in the younger age group (adjusted probability: 72% vs. 63%; p<0.001), and radiation therapy was more likely in younger RC patients (adjusted probability: 53% vs. 48%; p<0.001). Patients younger than screening age had better overall disease-specific survival (Hazard ratio: 0.77; p<0.001), despite a larger proportion presenting with advanced disease. Conclusions Colorectal cancer patients diagnosed before age 50 are more likely to present with advanced stage disease. However, they receive more aggressive therapy and achieve longer disease-specific survival, despite the greater proportion with advanced-stage disease. These findings suggest the need for improved risk assessment and screening decisions for younger adults.

STRUCTURED ABSTRACT PURPOSE Individuals from disadvantaged communities are among millions of uninsured Americans gaining insurance under the Affordable Care Act. The extent to which health insurance can mitigate the effects of the social determinants of health on cancer care is unknown. METHODS We linked the Surveillance, Epidemiology, and End Results (SEER) registries to US-Census data to study patients diagnosed with the 4 leading causes of cancer deaths between 2007–2011. We developed a county-level social determinants score using 5 measures of wealth, education and employment. We stratified patients into quintiles, with the lowest quintile representing the most disadvantaged communities. Logistic regression and Cox proportional hazards models were used to estimate associations and cancer-specific survival. RESULTS A total of 364,507 patients aged 18–64 years were identified (134,105 breast,106,914 prostate, 62,606 lung. and 60,881 colorectal). Overall, patients from the most disadvantaged communities (median household income=$42,885; 22% below poverty level; 17% college completion) were more likely to present with distant disease (Odds ratio [OR]=1.6; p<0.001) and less likely to receive cancer-directed surgery (OR=0.8; p<0.001) than the least disadvantaged communities (median income=$78,249; 9% below poverty; 42% college completion). The differences persisted across quintiles regardless of insurance status. The effect of having insurance on cancer-specific survival was more pronounced in disadvantaged communities (40% vs. 31% relative benefit at 3 years). However, it did not fully mitigate the effect of social determinants on mortality (Hazard Ratio 0.77 vs. 0.68; p<0.001). CONCLUSIONS Cancer patients from disadvantaged communities benefit most from health insurance and there is a reduction in disparities in outcome. However, the gap produced by social determinants of health cannot be bridged by insurance alone.

In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.

This is the first publication to date to analyze the mesothelioma National Cancer Data Base. Although survival remains poor, multimodality therapy with surgical resection is associated with the best survival for MPM. Further research is needed to improve survival and overall patient outcomes.

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Patients with obstructive sleep apnea (OSA) who are not treated with positive airway pressure preoperatively are at increased risks for cardiopulmonary complications after general and vascular surgery. Improving the recognition of OSA and ensuring adequate treatment may be a strategy to reduce risk for surgical patients with OSA.

Postoperative transfusions after noncardiac surgery are associated with increased adverse postoperative outcomes, with the exception of postoperative myocardial infarction. Hospitals that are liberal in their transfusion practices have higher 30-day mortality rates, suggesting potential interventions for quality improvement.

Objective Clostridium difficile infection (CDI) is a common hospital-acquired infection. Previous reports on CDI's incidence, risk factors and impact on resources in the surgical population are limited. In this context, we study CDI across diverse surgical settings. Methods We prospectively identified patients with laboratory-confirmed postoperative CDI after 40 different general, vascular, or gynecologic surgeries at 52 academic & community hospitals between 7/2012-9/2013. We used multivariable regression models to identify CDI risk factors and its impact on resource utilization. Results Of 35,363 patients, 179 (0.51%) developed postoperative CDI. The highest rates of CDI were after lower-extremity amputation (2.6%), followed by bowel resection or repair (0.9%) and gastric or esophageal operations (0.7%). Gynecologic and endocrine operations had the lowest rates (0.1 & 0%, respectively). On multivariable analyses, older age, chronic immunosuppression, hypoalbuminemia (≤3.5 g/dL) and preoperative sepsis were associated with CDI. Use of prophylactic antibiotics was not independently associated with CDI, neither was sex, BMI, surgical priority, weight loss or comorbid conditions. Three procedure groups had higher odds of postoperative CDI: Lower-extremity amputations (aOR=3.5, p=0.03), gastric or esophageal operations (aOR=2.1, p=0.04) and bowel resection or repair (aOR=2, p=0.04). Postoperative CDI was independently associated with increased length of stay (mean 13.7 vs 4.5 days), emergency department presentations (18.9 vs 9.1%) and readmissions (38.9 vs 7.2%, all p<0.001). Conclusions Incidence of postoperative CDI varies by surgical procedure. Postoperative CDI is also associated with higher rates of extended length of stay, emergency room presentations & readmissions, which places a potentially preventable burden on hospital resources.