Death after colectomy: it's later than we think.
BACKGROUND
Clinical outcomes are increasingly subject to objective assessment and professional accountability. Informed consent relies on accurate estimation of operative risk. Current scoring systems for assessment of operative mortality after colorectal surgery (CRS) almost uniformly report 30-day mortality and may not represent true risk.


METHODS
Prospective cohort.


METHODS
University-affiliated Veterans Affairs Medical Center.


METHODS
All patients who underwent resections of the colon and/or rectum (as the principal operation) at a single hospital whose data are captured in the Veterans Affairs National Surgical Quality Improvement Program (VA-NSQIP) database from January 1, 2000, through December 31, 2006.


METHODS
Mortality at 30 days and 90 days.


RESULTS
The VA-NSQIP cohort included 186 patients who underwent CRS, including 148 patients who underwent elective procedures (79.6%) and 38 patients who underwent emergency procedures (20.4%). All but 8 patients were men, with a median age of 67 years (range, 26-92 years). Laparoscopic operations comprised 24.2% and open operations comprised 75.8%. Most (60.8%) were performed for neoplasms. The actual 30-day mortality rates (all, elective, and emergency procedures) were 4.3%, 1.4%, and 15.8%, respectively. These rates closely mirrored the calculated VA-NSQIP risk-adjusted observed-to-expected ratio for 30-day mortality (4.8%, 1.8%, and 18.2%, respectively). However, mortality at 90 days increased substantially to 9.1%, 4.1%, and 28.9%, respectively.


CONCLUSIONS
The 30-day mortality significantly underreports the true risk of death after CRS. The 90-day mortality rate should be included as a standard outcome measure after CRS because it serves as a better estimation of risk for counseling patients.
Visser
Brendan C
BC
Department of Surgery, Stanford University School of Medicine, Stanford, California, USA. Brendan.Visser@va.gov
Keegan
Hugh
H
Martin
Molinda
M
Wren
Sherry M
SM
D000046:Academic Medical Centers; D017677:Age Distribution; D002140:California; D002423:Cause of Death; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods / Q000401:mortality*; D003113:Colonoscopy / Q000379:methods / Q000401:mortality; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006787:Hospitals, Veterans; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013997:Time Factors; D016896:Treatment Outcome