Social deprivation and outcomes in colorectal cancer.
BACKGROUND
The aim of this study was to examine the influence of social deprivation on postoperative mortality and length of stay in patients having surgery for colorectal cancer.


METHODS
Data were extracted from the Association of Coloproctology of Great Britain and Ireland database of patients presenting between April 2001 and March 2002. The effect of social deprivation, measured by the Townsend score, on 30-day postoperative mortality and length of stay was evaluated by two-level hierarchical regression analysis.


RESULTS
A total of 7290 (86.8 percent) patients underwent surgery. Operative mortality was 6.7 percent and median length of stay 11 days. Deprivation indices were significantly higher in patients with Dukes' 'D' cancers, undergoing emergency surgery and with higher American Society of Anesthesiologists (ASA) grades (P<0.005). Worsening deprivation was associated with higher operative mortality and longer stay (P=0.014). For each unit increase in deprivation, there was 2.9 (95 percent confidence interval 0.5 to 5.2) percent increase in 30-day mortality. On multifactorial analysis, social deprivation was an independent predictor of length of stay, but its effect on operative mortality was explained by differences in ASA grade, operative urgency and Dukes' classification.


CONCLUSIONS
Social deprivation was an independent risk factor of postoperative length of stay and associated with higher postoperative mortality. These results have important implications for risk modelling of postoperative outcomes.
Smith
J J
JJ
Department of Surgery, West Middlesex Hospital, Isleworth, and Department of Biosurgery and Surgical Technology, Imperial College London, UK.
Tilney
H S
HS
Heriot
A G
AG
Darzi
A W
AW
Forbes
H
H
Thompson
M R
MR
Stamatakis
J D
JD
Tekkis
P P
PP
D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000523:psychology; D011446:Prospective Studies; D011610:Psychosocial Deprivation; D012307:Risk Factors; D016896:Treatment Outcome