Does it matter where you get your surgery for colorectal cancer?

Hamidi, Mohammad; Hanna, Kamil; Omesiete, Pamela; Cruz, Álejandro; Ewongwo, Agnes; Pandit, Viraj; Joseph, Bellal; Nfonsam, Valentine

doi:10.1007/s00384-019-03436-6

Cited by 20 publications

(15 citation statements)

References 23 publications

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“…Longer operative time for ileostomy reversal while only one indicator, might be associated with modifiable and nonmodifiable factors that can interplay and potentiate the negative risks on postoperative outcomes and thus it is important indicator to help identify patients at increased risk before the complications occur. Complexity of cases and intraoperative events are mostly non-modifiable factors, while for surgeon's expertise, there has been support for regionalization of care to specialty centers to mitigate the disparities and improve outcomes [30][31][32][33]. The same planning could be applied to ileostomy reversal cases, where patients identified as highrisk are directed to specialty care centers that are better equipped to manage higher complexity patients.…”

Section: Discussionmentioning

confidence: 99%

Predictors of complications from stoma closure in elective colorectal surgery: an assessment from the American College of Surgeons National Surgical Quality Improvement Program (ACSNSQIP)

et al. 2020

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Background There is significant morbidity after diverting ileostomy closure, so identifying predictors of complications could be of great benefit. The aim of our study was to evaluate the incidence and risk factors for postoperative morbidity after elective ileostomy closure. Methods The ACS-NSQIP dataset was evaluated for elective ileostomy closures from 1/1/2015 to 12/31/2016. Demographic characteristics, operative, and postoperative outcomes were evaluated. The primary outcome was 30-day major morbidity (Clavien class III and greater). Secondary outcomes were rates and predictors of major morbidity, superficial site infection (SSI), reoperation, and readmission from multivariate logistic regression modeling. Results We retrospectively evaluated 1885 patients. The median operative time was 65 (IQR 50–90) minutes and median length of stay was 3 (IQR 2–5) days. Major morbidity was recorded in 6.7%, including mortality (1.0%), deep/organ space SSI (2.6%), dehiscence (0.8%), reintubation (0.5%), sepsis (1.7%), septic shock (0.8%), and reoperation (3.7%). Readmission was recorded in 9.7% and 6.2% had SSI. Multivariate logistic regression showed male sex (OR 1.584; 95% CI 1.068–2.347; p = 0.022) and longer operative time (OR 1.004; 95% CI 1.001–1.007; p = 0.009) were among those variables associated with increased odds of major morbidity. Dyspnea (OR 2.431; 95% CI 1.139–5.094; p = 0.021) and longer operative time (OR 1.003; 95% CI 1.001–1.007; p = 0.034) were among the independent risk factors for SSI. Male sex (OR 2.246; 95% CI 1.297–3.892; p = 0.004, chronic obstructive pulmonary disease (OR 2.959; 95% CI 1.153–7.591; p = 0.024), and longer operative time (OR 1.005; 95% CI 1.001–1.009; p = 0.011) were associated with increased odds of reoperation. Chronic obstructive pulmonary disease (OR 2.578; 95% CI 1.338–4.968; p = 0.005), wound infection (OR 2.680; 95% CI 1.043–6.890; p = 0.041), and inflammatory bowel disease (OR 2.565; 95% CI 1.203–5.463; p = 0.015) were associated with increased odds of readmission. Conclusions Elective stoma closure has significant risk of morbidity. Patients with longer operative times were at increased risk for major morbidity, overall SSI, and reoperation. From the analysis, factors specifically associated with major morbidity, overall infectious complications, readmissions, and reoperations were identified. This information can be used to prospectively prepare for these high-risk patients, potentially improving postoperative outcomes. Electronic supplementary material The online version of this article (10.1007/s10151-020-02307-5) contains supplementary material, which is available to autho...

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Section: Discussionmentioning

confidence: 99%

Predictors of complications from stoma closure in elective colorectal surgery: an assessment from the American College of Surgeons National Surgical Quality Improvement Program (ACSNSQIP)

et al. 2020

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“…The control of risk factors for complications after colorectal surgery has been actively pursued throughout the years. Many short-and long-term outcomes have been considerably ameliorated by the standardization of the surgical procedures and centralization to high-volume hospitals [6,7]. Nevertheless, a substantial number of patients undergoing colorectal surgery experience postoperative morbidity, mainly in terms of postoperative ileus (POI) (10-30%), surgical-site infections (SSIs) (6.5-20%), anastomotic leak (AL) (2.7-20%) and re-admission (8.1-11.8%) [8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review

et al. 2021

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Background The gut microbiota (GM) has been proposed as one of the main determinants of colorectal surgery complications and theorized as the “missing factor” that could explain still poorly understood complications. Herein, we investigate this theory and report the current evidence on the role of the GM in colorectal surgery. Methods We first present the findings associating the role of the GM with the physiological response to surgery. Second, the change in GM composition during and after surgery and its association with colorectal surgery complications (ileus, adhesions, surgical-site infections, anastomotic leak, and diversion colitis) are reviewed. Finally, we present the findings linking GM science to the application of the enhanced recovery after surgery (ERAS) protocol, for the use of oral antibiotics with mechanical bowel preparation and for the administration of probiotics/synbiotics. Results According to preclinical and translational evidence, the GM is capable of influencing colorectal surgery outcomes. Clinical evidence supports the application of an ERAS protocol and the preoperative administration of multistrain probiotics/synbiotics. GM manipulation with oral antibiotics with mechanical bowel preparation still has uncertain benefits in right-sided colic resection but is very promising for left-sided colic resection. Conclusions The GM may be a determinant of colorectal surgery outcomes. There is an emerging need to implement translational research on the topic. Future clinical studies should clarify the composition of preoperative and postoperative GM and the impact of the GM on different colorectal surgery complications and should assess the validity of GM-targeted measures in effectively reducing complications for all colorectal surgery locations.

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“…A US study of colon cancer resection in 2011 12 reported a slightly lower range of serious postoperative complications (19.4% in urban populations and 24.9% in rural populations) among all cases undergoing resection at age 518 years; however, among US colorectal cancer resections in 2014-2015, serious complications were reported in 21.3% to 33.9%, depending on hospital volume, of all resections among those aged 518. 13 Reports of postoperative mortality following major large bowel resection for CRC in the contemporary era are characterized by substantial variability in terminology, which causes difficulties in making comparisons between reports, or between our study and other reports. Some of the reports cited above define 30-day and/or 90-day mortality, while others define a composite measure comprised of 30-day mortality plus in-hospital mortality occurring at any time during the index admission regardless of length of stay prior to death, or in-hospital mortality only without any dimension of time since resection.…”

Section: Discussionmentioning

confidence: 85%

Morbidity and mortality following major large bowel resection for colorectal cancer detected by a population-based screening program

Paszat

Sutradhar

Corn³

et al. 2020

J Med Screen

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Background and aims In 2008, Ontario initiated a population-based colorectal screening program using guaiac fecal occult blood testing. This work was undertaken to fill a major gap in knowledge by estimating serious post-operative complications and mortality following major large bowel resection of colorectal cancer detected by a population-based screening program. Methods We identified persons with a first positive fecal occult blood result between 2008 and 2016, at the age of 50–74 years, who underwent a colonoscopy within 6 months, and proceeded to major large bowel resection for colon cancer within 6 months or rectosigmoid/rectal cancer within 12 months, and identified an unscreened cohort of resected cases diagnosed during the same years at the age of 50–74 years. We identified serious postoperative complications and readmissions ≤30 days following resection, and postoperative mortality ≤30 days, and between 31 and 90 days among the screen-detected and the unscreened cohorts. Results Serious post-operative complications or readmissions within 30 days were observed among 1476/4999 (29.5%) cases in the screen-detected cohort, and among 3060/8848 (34.6%) unscreened cases. Mortality within 30 days was 43/4999 (0.9%) among the screen-detected cohort, and 208/8848 (2.4%) among the unscreened cohort. Among 30 day survivors, mortality between 31 and 90 days was 28/4956 (0.6%) and 111/8640 (1.3%), respectively. Conclusion Serious post-operative complications, readmissions, and mortality may be more common following major large bowel resection for colorectal cancer between the ages of 50 and 74 among unscreened compared to screen-detected cases.

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Does it matter where you get your surgery for colorectal cancer?

Cited by 20 publications

References 23 publications

Predictors of complications from stoma closure in elective colorectal surgery: an assessment from the American College of Surgeons National Surgical Quality Improvement Program (ACSNSQIP)

Predictors of complications from stoma closure in elective colorectal surgery: an assessment from the American College of Surgeons National Surgical Quality Improvement Program (ACSNSQIP)

The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review

Morbidity and mortality following major large bowel resection for colorectal cancer detected by a population-based screening program

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