Postoperative medical complications are the main cause of early death after emergency surgery for colonic cancer

Iversen, Lene Hjerrild; Bülow, Steffen; Christensen, Ib Jarle; Laurberg, Søren; Harling, Henrik

doi:10.1002/bjs.6114

Cited by 118 publications

(109 citation statements)

References 20 publications

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“…Although many studies on colon cancer surgery include emergency surgery as a risk factor in multivariate models, there is no common definition between studies of requisites to define an emergency operation. The proportion of emergency operations therefore varies, with some studies reporting lower frequencies of emergency procedures [2][3][4][5]14], while other studies have higher frequencies [12,13,21] when compared to the findings of the present study. A defined time period between admission and surgery is often used as a criterion when classifying an operation as being an emergency [2,14] .…”

Section: -contrasting

confidence: 53%

Risk Factors for Local Recurrence after Emergency Resection for Colon Cancer: Scenario in Sweden

Brännström

Gunnarsson²

2016

Dig Surg

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Background/Aims: Patients undergoing emergency resection for colon cancer have a worse outcome both in terms of short- and long-term survival than those having elective surgery. The aim of this population-based study was to determine factors associated with increased risk for local recurrence following emergency resection. Methods: The Stockholm-Gotland Healthcare Region Colon Cancer Register was used to identify all colon cancer patients who had undergone emergency colon resection with curative intent in that region 1997-2007. Patient records were scrutinised to obtain any missing information. The influence of the following factors was assessed: indication for emergency resection; time between admission and surgery; surgery daytime or at night; American Association of Anesthesiologists score; volume of blood lost; and T- and N-stage. Our endpoint was loco-regional recurrence. Results: Apart from stage, perforation as indication for emergency surgery was the only factor that influenced the risk for local recurrence (hazard ratio 1.96; 95% CI 1.12-3.43). Conclusion: In this study, the only factor associated with local recurrence after emergency resection for colon cancer was preoperative perforation. This implies that changes in our current management algorithm would be unlikely to lead to improvement. Efforts should therefore concentrate on reducing the proportion of patients operated on an emergency basis.

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Section: -contrasting

confidence: 53%

Risk Factors for Local Recurrence after Emergency Resection for Colon Cancer: Scenario in Sweden

Brännström

Gunnarsson²

2016

Dig Surg

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“…Similarly, in a study among patients submitted to surgery for colonic cancer postoperative infectious complications were strong risk factors for early death [27]. Several studies have shown that prolonged operative time [25,27,28], wound class [29,30], emergency surgery [29,31], and number of surgical interventions [31], correlate with increased infection rate. Among patients of this study, metronidazole use duration was an independent risk factor for the development of infection caused by MDR-GNB.…”

Section: Discussionmentioning

confidence: 97%

Multi-drug-resistant gram-negative bacterial infection in surgical patients hospitalized in the ICU: a cohort study

Alexiou

Michalopoulos

Makris

et al. 2011

Eur J Clin Microbiol Infect Dis

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We sought to identify risk factors for postoperative infections, caused by multi-drug-resistant gram-negative bacteria (MDR-GNB) in surgical patients. This was a retrospective cohort study among patients hospitalized in the intensive care unit (ICU) for more than 5 days, following general surgical operations. Comparison of patients who developed infection caused by MDR-GNB with the remainder of the cohort showed that every minute of operative time, use of special treatments during hospitalization (antineoplastic, immunosuppressive or immunomodulating therapies), every day of metronidazole, and every day of carbapenems use, increased patients' odds to acquire an infection caused by MDR-GNB by 0.7%, 8.9 times, 9%, and 9%, respectively [OR (95% CI): 1.007 (1.003-1.011), p = 0.001; 8.9 (1.8-17.3), p = 0.004; 1.09 (1.04-1.18), p = 0.039; 1.09 (1.01-1.18), p = 0.023, respectively]. The above were adjusted in the multivariable analysis for the confounder of time distribution of infections caused by MDR-GNB. Finally, the secondary comparison, with patients that did not develop any infection, showed that patients who had received antibiotics, within 3 months prior to admission, had 3.8 times higher odds to acquire an infection caused by MDR-GNB [OR (95% CI): 3.8 (1.07-13.2), p = 0.002]. This study depicts certain, potentially modifiable, risk factors for postoperative infections in patients hospitalized in the ICU for more than 5 days.

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“…In this series, we report no complications and no mortality in our small group. In cases of emergency, however, the results are associated with poor outcomes [3,5,32,33]. In fact, emergency colorectal procedures have been reported with a mortality rate as high as 21% [5,32].…”

Section: Discussionmentioning

confidence: 99%

Safety of robotic general surgery in elderly patients

et al. 2010

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As the life expectancy of people in Western countries continues to rise, so too does the number of elderly patients. In parallel, robotic surgery continues to gain increasing acceptance, allowing for more complex operations to be performed by minimally invasive approach and extending indications for surgery to this population. The aim of this study is to assess the safety of robotic general surgery in patients 70 years and older. From April 2007 to December 2009, patients 70 years and older, who underwent various robotic procedures at our institution, were stratified into three categories of surgical complexity (low, intermediate, and high). There were 73 patients, including 39 women (53.4%) and 34 men (46.6%). The median age was 75 years (range 70-88 years). There were 7, 24, and 42 patients included, respectively, in the low, intermediate, and high surgical complexity categories. Approximately 50% of patients underwent hepatic and pancreatic resections. There was no statistically significant difference between the three groups in terms of morbidity, mortality, readmission or transfusion. Mean overall operative time was 254 ± 133 min (range 15-560 min). Perioperative mortality and morbidity was 1.4% and 15.1%, respectively. Transfusion rate was 9.6%, and median length of stay was 6 days (range 0-30 days). Robotic surgery can be performed safely in the elderly population with low mortality, acceptable morbidity, and short hospital stay. Age should not be considered as a contraindication to robotic surgery even for advanced procedures.

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Postoperative medical complications are the main cause of early death after emergency surgery for colonic cancer

Abstract: Emergency surgery for colonic cancer is still associated with an increased risk of death. There is a need for a system providing increased safety in the perioperative period.

Cited by 118 publications

References 20 publications

Risk Factors for Local Recurrence after Emergency Resection for Colon Cancer: Scenario in Sweden

Risk Factors for Local Recurrence after Emergency Resection for Colon Cancer: Scenario in Sweden

Multi-drug-resistant gram-negative bacterial infection in surgical patients hospitalized in the ICU: a cohort study

Safety of robotic general surgery in elderly patients

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