Operative Outcomes Beyond 30-day Mortality

Al‐Refaie, Waddah B.; Parsons, Helen; Habermann, Elizabeth B.; Kwaan, Mary R.; Spencer, Michael P.; Henderson, William G.; Rothenberger, David A.

doi:10.1097/sla.0b013e318216f56e

Cited by 131 publications

(50 citation statements)

References 21 publications

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“…While the numerical difference is large, both data is insignificant at p=0.071 and p=0.392 respectively. This finding contradicts previous literature, whereby age has inevitably been identified as a risk factor for longer LOS and in needing higher postoperative care (13)(14)(15). However, caution must be exercised in the analysis of this data as the small study sample size could be limiting the analysis.…”

Section: Discussioncontrasting

confidence: 85%

“…Similarly, there were no differences in both the 30-day and 90-day postoperative mortality, p=0.269 and p=0.565 respectively, which was not observed before in previous literature (14,(16)(17)(18).…”

Section: Discussionsupporting

confidence: 58%

“…Past research has used arbitrary definitions varying from age 70 to 80 (13)(14)(15)(16)18,27), and this study has adopted an arbitrary cut-off of 75 years old. While having patients from a single tertiary center can standardise patient selection, it however provides only a very small cohort of patients and therefore limit generalisation of results.…”

Section: Discussionmentioning

confidence: 99%

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A comparative study of short-term outcomes of colorectal cancer surgery in the elderly population

Yen

Simillis

Choudhry

et al. 2017

Acta Chirurgica Belgica

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Section: Discussioncontrasting

confidence: 85%

Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

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A comparative study of short-term outcomes of colorectal cancer surgery in the elderly population

Yen

Simillis

Choudhry

et al. 2017

Acta Chirurgica Belgica

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“…30, 41, 42 We also could not measure preoperative physical status, which is associated with 30-day mortality. 30, 41–44 …”

Section: Discussionmentioning

confidence: 99%

Hospital and Geographic Variability in Two Colorectal Cancer Surgery Outcomes: Complications and Mortality After Complications

Schootman

Lian²,

Pruitt

et al. 2014

Ann Surg Oncol

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Background The purpose of this study was to describe hospital and geographic variation in 30-day risk of surgical complications and death among colorectal cancer (CRC) patients and the extent to which patient-, hospital-, and census-tract-level characteristics increased risk of these outcomes. Methods We included patients at least 66 years old with first primary stage I–III CRC from the 2000–2005 National Cancer Institute’s Surveillance, Epidemiology, and End Results data linked with 1999–2005 Medicare claims. A multilevel, cross-classified logistic model was used to account for nesting of patients within hospitals and within residential census tracts. Outcomes were risk of complications and death after a complication within 30 days of surgery. Results Data were analyzed for 35,946 patients undergoing surgery at 1,222 hospitals and residing in 12,187 census tracts; 27.2 % of patients developed complications, and of these 13.4 % died. Risk-adjusted variability in complications across hospitals and census tracts was similar. Variability in mortality was larger than variability in complications, across hospitals and across census tracts. Specific characteristics increased risk of complications (e.g., census-tract-poverty rate, emergency surgery, and being African-American). No hospital characteristics increased complication risk. Specific characteristics increased risk of death (e.g. census-tract-poverty rate, being diagnosed with colon (versus rectal) cancer, and emergency surgery), while hospitals with at least 500 beds showed reduced death risk. Conclusions Large, unexplained variations exist in mortality after surgical complications in CRC across hospitals and geographic areas. The potential exists for quality improvement efforts targeted at the hospital and/or census-tract levels to prevent complications and augment hospitals’ ability to reduce mortality risk.

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“…Al-Refaie et al 5 studied patients over 80 years of age undergoing colorectal surgery and found elderly patients to be prone to major complications (17%), prolonged length of stay (29%) and increased risk of 30-day mortality (6%). In their study, multivariable analysis demonstrated that older age independently predicted worse postoperative outcomes in the oldest old.…”

Section: Discussionmentioning

confidence: 99%

Advancing Age and 30‐Day Adverse Outcomes After Nonemergent General Surgeries

Gajdos

Kile

Hawn

et al. 2013

J American Geriatrics Society

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Background While some single center studies have demonstrated that major surgical operations are safe to perform in older adults, most multicenter database studies find advancing age to independently predict adverse postoperative outcomes. We hypothesized that thirty-day postoperative mortality, complications, failure to rescue rates and postoperative length of stay will increase with advancing age. Design Retrospective cohort study. Setting Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participants Patients undergoing non-emergent major general surgical operations between 2005 and 2008 were studied. Measures Postoperative outcomes of interest were complications occurring within 30 days of the index operation, return to OR within 30 days, failure to rescue after a postoperative complication, post-surgical length of stay and 30 day mortality. Results A total of 165,600 patients were studied. The rates of postoperative mortality, overall morbidity, and each type of postoperative complication increased as age increased. The rates of failure to rescue after each type of postoperative complication also increased with age. Mortality rates in patients ≥80 following renal insufficiency (43.3%), stroke (36.5%), myocardial infarction (35.6%), and pulmonary complications (25-39%) were particularly high. Median postoperative length of stay increased with age following surgical site infection, UTI, pneumonia, return to OR, and overall morbidity, but not after venous thromboembolism, stroke, myocardial infarction, renal insufficiency, failure to wean from the ventilator or reintubations. Conclusion Thirty-day mortality, complications and failure to rescue rates increase with advancing age following non-emergent general surgical operations. Patients over 80 years of age have especially high mortality following renal, cardiovascular, and pulmonary complications. As patient age advances, surgeons need to be more selective regarding who will benefit from the surgical intervention.

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Operative Outcomes Beyond 30-day Mortality

Cited by 131 publications

References 21 publications

A comparative study of short-term outcomes of colorectal cancer surgery in the elderly population

A comparative study of short-term outcomes of colorectal cancer surgery in the elderly population

Hospital and Geographic Variability in Two Colorectal Cancer Surgery Outcomes: Complications and Mortality After Complications

Advancing Age and 30‐Day Adverse Outcomes After Nonemergent General Surgeries

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