COPD is a clear risk factor for increased use of resources and adverse outcomes in patients undergoing intervention for colorectal cancer: a nationwide study in Spain

Abstract

BackgroundWe hypothesized that patients undergoing surgery for colorectal cancer (CRC) with COPD as a comorbidity would consume more resources and have worse in-hospital outcomes than similar patients without COPD. Therefore, we compared different aspects of the care process and short-term outcomes in patients undergoing surgery for CRC, with and without COPD.MethodsThis was a prospective study and it included patients from 22 hospitals located in Spain – 472 patients with COPD and 2,276 patients without COPD undergoing surgery for CRC. Clinical variables, postintervention intensive care unit (ICU) admission, use of invasive mechanical ventilation, and postintervention antibiotic treatment or blood transfusion were compared between the two groups. The reintervention rate, presence and type of complications, length of stay, and in-hospital mortality were also estimated. Hazard ratio (HR) for hospital mortality was estimated by Cox regression models.ResultsCOPD was associated with higher rates of in-hospital complications, ICU admission, antibiotic treatment, reinterventions, and mortality. Moreover, after adjusting for other factors, COPD remained clearly associated with higher and earlier in-hospital mortality.ConclusionTo reduce in-hospital morbidity and mortality in patients undergoing surgery for CRC and with COPD as a comorbidity, several aspects of perioperative management should be optimized and attention should be given to the usual comorbidities in these patients.

CCR-CARESS score for predicting operative mortality in patients with colorectal cancer

“…Although this study took into account all of the co‐morbidities included in the Charlson index and the ASA grade, only COPD was an independent factor for both explaining and predicting fatal outcome. The present authors recently published outcomes in this same cohort for patients with and those without COPD, reporting worse outcomes and higher resource consumption when COPD was present. Palliative aims generally reflect the impossibility of curative surgery for colorectal cancer due to the severity or extension of the tumour, possible aggravating factors (such as perforation or occlusion), and possibly the patient's clinical status.…”

A Prediction Model for Severe Complications after Elective Colorectal Cancer Surgery in Patients of 70 Years and Older

“…Possible future research could study whether outcomes of surgery improve when predictors of complications such as low physical functioning and pulmonary comorbidity are corrected or improved by preoperative interventions such as prehabilitation [45], pulmonary optimisation [46] and geriatric comanagement [47]. It is possible that the GerCRC model can be improved in the future by adding information on cognitive functioning.…”

Results after 10 years of colorectal cancer screenings in Spain: Hospital incidence and in-hospital mortality (2011–2016)

“…In the same way, differences in costs between cancer types and stages, patients age and comorbidity status have been documented in several occasions and should be taken into account in future studies for the optimisation of healthcare protocols [30,31].…”