Burden of Emergency and Non-emergency Colorectal Cancer Surgeries in West Virginia and the USA

Abstract

Purpose Elective surgical resection is the curative treatment for colorectal cancer (CRC). Up to 30 % of patients present as surgical emergencies. The objective was to determine the association between presenting with an emergency condition and consequent outcomes of CRC surgery in the Appalachian state of West Virginia (WV) in comparison to the rest of the USA. Methods Patients diagnosed with CRC who underwent a surgical procedure from January 1, 2003 to December 31, 2007 were selected, and those with a diagnosis requiring emergency surgery were identified. Primary outcome measures were length of stay (LOS), total hospital charges, and inpatient death. Results Mean LOS was higher for WV. Mean charges were higher for the USA than for WV. Inpatient deaths in WV were greater than the rest of the USA. Those undergoing emergency surgery spent 51.9 % (β=0.40) more days in the hospital than those who did not. For WV, LOS was 7.6 % (β=0.07) higher than that of the US. Hospital charges for those that underwent emergency resection were 68.3 % (β= 0.52) higher than those who did not. The odds of in-hospital death were 1.68 (95 % CI=1.42–1.98) times greater in WV than in the USA. Those that underwent emergency surgery had a nearly four times (OR 3.88; 95 % CI=3.74–4.03) greater chance of in-hospital death. Conclusions The study stresses the ongoing burden of emergency surgeries in many states around the nation and the need to increase awareness about CRC screening practices, especially in patients who are at increased risk of the disease.

Colorectal Surgery in Kidney Transplant Recipients: A Decade of Trends and Outcomes in the United States

“…The important finding is that half of all surgical procedures performed in this population are done on an emergent basis, which is independently associated with worse outcomes as seen in our results and other studies. 12 Diverticular disease is the most common indication for colon surgery in the kidney transplant population, accounting for 48 per cent of cases. Several studies have shown an increased incidence of acute diverticulitis in the kidney transplant population.…”

An acute care surgery service expedites the treatment of emergency colorectal cancer: a retrospective case–control study

“…However, the management of diseases which are commonly encountered by ACS services do not usually require long-term surveillance for disease recurrence [ 16 , 20 ]. The acute care of emergency CRC patients therefore presents a relatively more complex challenge as it requires the coordination of multiple specialties, including gastroenterologists, surgeons, and oncologists (medical and/or radiation) [ 2 , 3 , 5 , 8 ]. While ACS services in the United States are typically staffed by subspecialty trauma and acute care surgeons [ 19 , 20 ], many Canadian ACS teams are run by surgeons who also routinely perform cancer operations as part of their elective practices [ 14 , 21 ].…”

Clinico-pathological features of colon cancer patients undergoing emergency surgery: a comparison between elderly and non-elderly patients

“…The latter one was previously considered a first-choice procedure in emergency colon surgery since it is fast to perform and prevents anastomotic leakage, but it requires a second stage to reverse the colostomy [38]. Therefore, there has been reported a shift regarding the surgical approach with a higher rate of one-stage procedure being performed [6,39, 40, 41]. Many studies, however, still report an increasing number of surgical procedures involving the creation of a diverting stoma in elderly patients [42].…”