title: Emergency surgery for colonic cancer in a defined population.
abstract: BACKGROUND
  The aim of this study was to identify risk factors in emergency surgery for colonic cancer in a large population and to investigate the economic impact of such surgery.
  
  
  METHODS
  Data from the colonic cancer registry (1997-2001) of the Uppsala/Orebro Regional Oncological Centre were analysed and classified by hospital category. Some 3259 patients were included; 806 had an emergency and 2453 an elective procedure. Data for calculating effects on health economy were derived from a national case-costing register.
  
  
  RESULTS
  Patients who had emergency surgery had more advanced tumours and a lower survival rate than those who had an elective procedure (5-year survival rate 29.8 versus 52.4 per cent; P < 0.001). There was a stage-specific difference in survival, with poorer survival both for patients with stage I and II tumours and for those with stage III tumours after emergency compared with elective surgery (P < 0.001). Emergency surgery was associated with a longer hospital stay (mean 18.0 versus 10.0 days; P < 0.001) and higher costs (relative cost 1.5 (95 per cent confidence interval 1.4 to 1.6)) compared with elective surgery. The duration of hospital stay was the strongest determinant of cost (r(2) = 0.52, P < 0.001).
  
  
  CONCLUSIONS
  Emergency surgery for colonic cancer is associated with a stage-specific increase in mortality rate.
authors.affiliation: Department of Surgical Sciences, Federation of County Councils, Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Jestin
authors.forename: J
authors.initials: J
authors.lastname: Nilsson
authors.forename: M
authors.initials: M
authors.lastname: Heurgren
authors.forename: L
authors.initials: L
authors.lastname: Påhlman
authors.forename: B
authors.initials: B
authors.lastname: Glimelius
authors.forename: U
authors.initials: U
authors.lastname: Gunnarsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003110:Colonic Neoplasms / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D017281:Cost of Illness; D017558:Elective Surgical Procedures / Q000191:economics / Q000401:mortality; D004638:Emergency Treatment / Q000191:economics* / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology