Poor 1-year survival in elderly patients undergoing nonelective colorectal resection

Abstract

Background: Colorectal resection in elderly patients is associated with significant morbidity and mortality, especially in an emergency setting.

Objectives: This study aims to quantify the risks associated with nonelective colorectal resection up to 1 year after surgery in elderly patients.

Design: This is a population-based observational study.

Setting: Data were obtained from the Hospital Episode Statistics database.

Population: All patients aged 70 years and older who underwent a nonelective colorectal resection in an English National Health Service Trust hospital between April 2001 and March 2008 were included.

Main outcome measures: : The primary outcomes measured were 30-day in hospital mortality, 365-day mortality, unplanned readmission within 28 days of discharge, and duration of hospital stay.

Results: During the study period, 36,767 nonelective colorectal resections were performed in patients aged ≥ 70 years in England. Patients were classified into 3 age groups: A (70-75 years), B (76-80 years), and C (>80 years). Thirty-day mortality was 17.0%, 23.3%, and 31.0% in groups A, B, and C (p < 0.001). The overall 30-day medical complication rate was 33.7%, and the reoperation rate was 6.3%. Cardiac and respiratory complications were significantly higher in group C (22.2% and 18.2%, p < 0.001). Mortality in Group C was 51.2% at 1-year postsurgery. Advanced age was an independent determinant of mortality in risk-adjusted regression analyses.

Limitations: This is a retrospective analysis of a prospective database. Stage of disease at presentation, severity of complications, and cause of death cannot be ascertained from this database.

Conclusions: In this population-based study, half of all English patients aged over 80 years undergoing nonelective colorectal resection died within 1 year of surgery. Further research is required to identify perioperative and postdischarge strategies that may improve survival in this vulnerable cohort.