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. 2024 Nov 27;29(1):4.
doi: 10.1007/s10151-024-03040-z.

Predictors of perioperative morbidity in elderly patients undergoing colorectal cancer resection

S Y Parnasa #  1 , N Lev-Cohain #  2 , R Bader  1 , A Shweiki  1 , I Mizrahi  1 , M Abu-Gazala  1 , A J Pikarsky  1 , N Shussman  3
Affiliations

Predictors of perioperative morbidity in elderly patients undergoing colorectal cancer resection

S Y Parnasa et al. Tech Coloproctol. .

Abstract

Aim: Colorectal cancer resection in the elderly may be associated with significant morbidity. This study aimed to assess perioperative morbidity in elderly patients undergoing colorectal cancer resection and to investigate risk factors for postoperative complications.

Materials and methods: Consecutive patients aged ≥ 75 years undergoing colorectal cancer resection with curative intent between January 2014 and December 2021 at our institution were included. We evaluated risk factors for postoperative complications, length of hospital stays (LOS), 30-day readmission, and 90-day mortality rates.

Results: A total of 843 patients underwent colorectal cancer resection during the study period, of whom 202 patients were 75 years or older. Advanced age was associated with postoperative complications (Clavien-Dindo score > 3b, p = 0.001). Sarcopenia, preoperative plasma albumin < 3.5 g/dL, and open and urgent surgery were significantly correlated with major complications (p = 0.015, p = 0.022, p = 0.003, and p < 0.001, respectively). LOS was longer in elderly patients with a modified 5-item Frailty Index (5-mFI) ≥ 2 and low preoperative serum albumin levels, as well as following open surgery (p = 0.006, p = 0.001 and p < 0.001, respectively). Sarcopenia and preoperative plasma albumin < 3.5 g/dL were predictors for 90-day mortality (p = 0.004 and p > 0.001).

Conclusion: Advanced age, sarcopenia, preoperative hypoalbuminemia, 5-mFI ≥ 2, and open or urgent surgery may serve as predictors for postoperative morbidity in the elderly population.

Keywords: Colorectal cancer; Elderly; Frailty; Modified 5-item frailty index; Perioperative complications; Sarcopenia.

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Conflict of interest statement

Declarations. Conflict of interests: The authors declare no competing interests. Ethics approval: Approval for this study was obtained from the Institutional Review Board of the Hadassah Hebrew University Medical Center (approval no. HMO-0766-20), and the study was conducted in adherence to the principles of the 1964 Declaration of Helsinki. Consent: Institutional Review Board has granted exemption from requiring participants’ informed consent due to the retrospective nature of this study.

Figures

Fig. 1
Fig. 1
Axial image from a non-contrast preoperative computed tomography scan of an 80-year-old patient. The area of the right psoas muscle, measured at the level of L3, is 241 mm2 with an average density of 18.2 Hounsfield units
Fig. 2
Fig. 2
Axial image from a non-contrast preoperative computed tomography scan of a 77-year-old patient. The area of the right psoas muscle, measured at the level of L3, is 717 mm2 with an average density of 49.7 Hounsfield units
See this image and copyright information in PMC

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