Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients

Abstract

Background The frailty of the very elderly patients who undergo surgery for colorectal cancer negatively influences postoperative mortality. This study aimed to identify risk factors for postoperative mortality in octogenarian and nonagenarian patients who underwent surgical treatment for colorectal cancer. Methods This is a single institution retrospective study. The primary outcomes were risk factors for postoperative mortality. The variables of the octogenarians and nonagenarians were compared by using t-test, chi-square test, and Fisher exact test. A multivariate logistic regression analysis was carried out on the combined cohorts. Results we identified 319 octogenarians and 43 nonagenarians (N = 362) who underwent surgery for colorectal cancer at the Sant’Orsola-Malpighi university hospital in Bologna between 2011 and 2015. The 30-day post-operative mortality was 6% (N = 18) among octogenarians and 21% (N = 9) for the nonagenarians. The groups significantly differed in the type of surgery (elective vs. urgent surgery, p < 0.0001), ASA score (p = 0.0003) and rates of 30-day postoperative mortality (6% vs. 21%, p = 0.0003). In the multivariate analysis ASA > III (OR 2.37, 95% CI [1.43–3.93], p < 0,001), and urgent surgery (OR 2.17, 95% CI [1.17–4.04], p = 0.014) were associated to post-operative mortality. On the contrary, pre-operative albumin≥3.4 g/dL (OR 0.14, 95% CI [0.05–0.52], p = 0.001) was associated with a protective effect on postoperative mortality. Conclusions In the very elderly affected by colorectal cancer, preoperative nutritional status and pre-existing comorbidities, rather than age itself, should be considered as selection criteria for surgery. Preoperative improvement of nutritional status and ASA risk assessment may be beneficial for stratification of patients and ultimately for optimizing outcomes.

Assessment of inflammatory markers, disease severity and comorbidities in very elderly patients with acute respiratory diseases

“…The established role of higher CRP and low serum albumin levels as CRP to serum albumin ratio has a crucial role for predicting increased in-hospital mortality in our cohort, which seems notable given that hypoalbuminemia has been considered to offer strong prognostic information additional to usual prognostic variables for the prediction of in-hospital mortality in elderly patients admitted for acute cardiac conditions [25][26][27]. Past studies also reported the association of hypoalbuminemia with mortality and severity of pneumonia in hospitalized patients with community acquired pneumonia [28] and with mortality after oncological surgery among the elderly [29,30]. Repeated microalbuminuria testing can be used for an early predictor of development of nephropathy in patients with type 1 diabetes rather than mortality in all age groups [31].…”

The Usefulness of Inflammation-based Prognostic Scores for the Prediction of Postoperative Mortality in Patients Who Underwent Intestinal Resection for Acute Intestinal Ischemia

“…Duron et al demonstrated that postoperative mortality after major digestive surgery increased significantly among patients aged 65-74 years, and age ≥65 years was by itself an independent risk factor for mortality (odds ratio (OR), 2.21; 95% (CI), 1.36-3.59; p=0.001). Also, six independent risk factors of postoperative mortality were characteristic of elderly patients: age ≥85 years, emergency surgery, anemia, WBC > 10,000/mm³, ASA class IV, and a palliative cancer operation [15]. In brief, emergency surgery should be centralized to improve outcomes in old patients.…”

Does frailty predict postoperative outcomes in geriatric patients receiving surgery for colorectal cancer? A systematic review and meta-analysis

“…Competing risk models including functional and nutritional factors will be critical in classifying geriatric patients according to their frailty status [63].Third, as an important confounder affecting prognosis, emergency surgery was not absolutely eliminated in this study, although we attempted to subanalyze the patients who underwent elective surgery. The positive correlation between emergent surgical presentation and postoperative mortality in elderly patients undergoing CRC surgery was con rmed in previous studies [65,66]. Given that an emergent surgical presentation in a senior patient frequently points at a diagnosis of bowel obstruction or perforation, these two conditions often indicate an advanced stage and carry a poor prognosis [65].…”

“…The positive correlation between emergent surgical presentation and postoperative mortality in elderly patients undergoing CRC surgery was con rmed in previous studies [65,66]. Given that an emergent surgical presentation in a senior patient frequently points at a diagnosis of bowel obstruction or perforation, these two conditions often indicate an advanced stage and carry a poor prognosis [65]. Also, it is unlikely that preoperative assessment and prehabilitation training can be implemented in these patients.…”