Impact of Comorbidities on the Outcomes of Older Patients Receiving Rectal Cancer Surgery

Chang, Huihsien; Shih, Shou‐Chuan; Lin, Fu-Man

doi:10.1016/j.ijge.2012.05.006

Cited by 10 publications

(5 citation statements)

References 33 publications

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“…With respect to case covariates age, sex and comorbidities like coagulopathies, heart diseases, lung diseases or fluid and electrolyte disorders were risk factors for poor patient outcome in both groups in this analysis, which is supported by the literature as well 26 43–48…”

Section: Discussionsupporting

confidence: 80%

Relationships between multiple patient safety outcomes and healthcare and hospital-related risk factors in colorectal resection cases: cross-sectional evidence from a nationwide sample of 232 German hospitals

et al. 2022

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ObjectivesStudies analysing colorectal resections usually focus on a specific outcome (eg, mortality) and/or specific risk factors at the individual (eg, comorbidities) or hospital (eg, volume) level. Comprehensive evidence across different patient safety outcomes, risk factors and patient groups is still scarce. Therefore the aim of this analysis was to investigate consistent relationships between multiple patient safety outcomes, healthcare and hospital risk factors in colorectal resection cases.DesignCross-sectional study.SettingGerman inpatient routine care data of colorectal resections between 2016 and 2018.ParticipantsWe analysed 54 168 colon resection and 20 395 rectum resection cases treated in German hospitals. The German Inpatient Quality Indicators were used to define colon resections and rectum resections transparently.Primary outcome measuresAdditionally to in-hospital death, postoperative respiratory failure, renal failure and postoperative wound infections we included multiple patient safety outcomes as primary outcomes/dependent variables for our analysis. Healthcare (eg, weekend surgery), hospital (eg, volume) and case (eg, age) characteristics served as independent covariates in a multilevel logistic regression model. The estimated regression coefficients were transferred into ORs.ResultsWeekend surgery, emergency admissions and transfers from other hospitals were significantly associated (ORs ranged from 1.1 to 2.6) with poor patient safety outcome (ie, death, renal failure, postoperative respiratory failure) in colon resections and rectum resections. Hospital characteristics showed heterogeneous effects. In colon resections hospital volume was associated with insignificant or adverse associations (postoperative wound infections: OR 1.168 (95% CI 1.030 to 1.325)) to multiple patient safety outcomes. In rectum resections hospital volume was protectively associated with death, renal failure and postoperative respiratory failure (ORs ranged from 0.7 to 0.8).ConclusionsTransfer from other hospital and emergency admission are constantly associated with poor patient safety outcome. Hospital variables like volume, ownership or localisation did not show consistent relationships to patient safety outcomes.Trial registration numberISRCTN10188560.

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Section: Discussionsupporting

confidence: 80%

Relationships between multiple patient safety outcomes and healthcare and hospital-related risk factors in colorectal resection cases: cross-sectional evidence from a nationwide sample of 232 German hospitals

et al. 2022

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“…Research involving cancer survivors with multimorbidity has shown variable relationships between multimorbidity and cancer outcomes including overall survival [16][17][18][19][20][21][22], treatment complications [23,24], and lower likelihood of guideline-concordant care [25][26][27]. Some studies also suggest significantly lower HRQOL among multimorbid survivors [28][29][30], but few studies have explored individual comorbidities and their associations with specific HRQOL outcomes.…”

Section: Introductionmentioning

confidence: 99%

Examination of individual and multiple comorbid conditions and health-related quality of life in older cancer survivors

Siembida

Smith

Potosky³

et al. 2021

Qual Life Res

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Purpose Older cancer survivors (≥ 65 years at diagnosis) are at high-risk for multimorbidity (2 + comorbid conditions). However, few studies have utilized a generalizable sample of older cancer survivors to understand how individual comorbid conditions, as opposed to total comorbidity burden, are associated with health-related quality of life (HRQOL). We examined associations between HRQOL outcomes (pain, fatigue, physical function), individual comorbidities (cardiovascular disease [CVD], lung disease, diabetes, arthritis) and total comorbidity (cancer-only, cancer + 1 condition, cancer + 2 or more conditions). Methods Utilizing a population-based sample of 2019 older cancer survivors, we tested associations between comorbid conditions and the HRQOL outcomes using generalized linear models. HRQOL domains were assessed using Patient-Reported Outcome Measurement Information System ® (PROMIS ® ) measures. Comorbidity was assessed via self-report. Results Cancer survivors with lung disease reported significantly worse physical functioning (β = − 4.96, p < 0.001), survivors with arthritis reported significantly higher pain (β = 4.37, p < 0.001), and survivors with CVD reported significantly higher fatigue (β = 3.45, p < 0.001) compared to survivors without each condition. Having cancer + 1 condition was not as strongly associated with all outcomes as when individual conditions were tested (e.g. pain: β = 3.09, p < 0.001). Having 2+ comorbidities had a stronger association with all outcomes (e.g. physical function: β = − 7.51, p < 0.001) than examining conditions individually. Conclusions Knowing the specific comorbid condition profile of an older cancer survivor provides insight into specific HRQOL outcomes that may be impaired in cancer survivorship, but understanding total comorbidity burden, regardless of the specific conditions, sheds light on survivors at-risk for multiple impairments in HRQOL. This information, taken together, can inform risk-stratified survivorship care.

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“…Neoadjuvant chemotherapy plus radiotherapy has revealed itself as a potential application as part of a new therapeutic trend in treating locally advanced cervical cancer patients 29 . Older patients with comorbidities are at a higher risk of in-hospital complications following rectal cancer surgery, whereas the presence of comorbidities did not show a significant adverse effect on 1-year mortality 30 , and a history of hypertension, diabetes, cardiovascular disease, or cerebrovascular disease was not a significant predictor of 1-year mortality.…”

Section: Discussionmentioning

confidence: 77%

Management of Gynecological Cancer Patients Older than 70 Years of Age

Chakalova¹

2015

International Journal of Gerontology

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s u m m a r y Background: The incidence of geriatric oncology patients has not been studied very well. A retrospective study of the incidence of geriatric patients with malignant gynecological disease is therefore presented. Patients and methods: From 1982 until 2006, a total of 8377 patients with gynecological malignancies were treated in our clinic, 834 (10%) of whom were aged 70 years. In the analysis, annual reports of the clinic were used and the personal histories of patients aged 70 years (834 patients) were analyzed. The statistical method used was Fisher's exact test. Results: The number of patients aged 70e74 years, 75e79 years, and 80 years were 528 (63.3%), 215 (25.8%), and 91 (10.9%), respectively. Endometrial cancer was detected in 240 cases (28.77%), ovarian cancer in 192 cases (23.02%), vulvar cancer in 180 cases (21.58%), cervical cancer in 169 cases (20.26%), uterine sarcoma in 37 cases (4.43%), and vaginal cancer in 16 cases (1.91%). The comorbidities included were hypertension, diabetes, cardiovascular disease, pulmonary disease, and cerebrovascular disease. Operation was performed in 655 cases (78%), radiation therapy only in 152 cases (18%), and chemotherapy only in 27 cases (3%). In the present study, the in-hospital complication rate occurred in 78 cases (9.3%). In the group of patients aged >80 years, the in-hospital complication rate occurred in 20 cases (21%). No case of death related to surgery occurred. Conclusion:The key in choosing the treatment therapy is the localization and the stage of the cancer, whereas patient age and different chronic diseases are relevant to the treatment strategies used. The cases of geriatric gynecological malignancies were treated following the same guidelines used for younger patients. An increase in elderly surgical cancer workload is inevitable in the coming years. The special needs of elderly cancer patients should be taken into consideration prior to treatment planning.

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Impact of Comorbidities on the Outcomes of Older Patients Receiving Rectal Cancer Surgery

Cited by 10 publications

References 33 publications

Relationships between multiple patient safety outcomes and healthcare and hospital-related risk factors in colorectal resection cases: cross-sectional evidence from a nationwide sample of 232 German hospitals

Relationships between multiple patient safety outcomes and healthcare and hospital-related risk factors in colorectal resection cases: cross-sectional evidence from a nationwide sample of 232 German hospitals

Examination of individual and multiple comorbid conditions and health-related quality of life in older cancer survivors

Management of Gynecological Cancer Patients Older than 70 Years of Age

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