title: Optimizing surgical care of colon cancer in the older adult population.
abstract: OBJECTIVE
  We have undertaken the current study to evaluate factors that correlate with postoperative complications in older patients undergoing surgery for colon cancer.
  
  
  METHODS
  The database of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) from years 2005 to 2008 was accessed. Patients age 65 and older were included according to Current Procedural Terminology and International Classification of Disease-9 codes. Preoperative and operative variables were examined and postoperative complications assessed using a combination of univariate and multivariate statistical models. Propensity score matching was used to control for nonrandomization of the database.
  
  
  RESULTS
  We found that patients undergoing laparoscopic (n = 2113) and open (n = 3801) surgery for the diagnosis of colon cancer were similar in age and gender. However, patients undergoing laparoscopic surgery were generally at lower risk for developing postoperative complications (16.1% vs. 25.4%, P < 0.005). Statistical models controlling for preoperative and operative variables demonstrated patients with elevated body mass index (odds ratio [OR] = 1.26), a history of chronic obstructive pulmonary disease (OR = 1.63), over age 85 (OR = 1.35), a surgery lasting longer than 4 hours (OR = 1.48), or having undergone an open operation (OR = 1.53) to have increased risk for developing postoperative complications. Propensity score match analysis confirmed these results.
  
  
  CONCLUSIONS
  Identification of preoperative factors that predispose patients to postoperative complications could allow for the institution of protocols that may decrease these events. Furthermore, expanding the role of laparoscopy in the treatment of older patients with colon cancer may decrease rates of postoperative complications.
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. kennedyg@surgery.wisc.edu.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kennedy
authors.forename: Victoria
authors.initials: V
authors.lastname: Rajamanickam
authors.forename: Erin S
authors.initials: ES
authors.lastname: O'connor
authors.forename: Noelle K
authors.initials: NK
authors.lastname: Loconte
authors.forename: Eugene F
authors.initials: EF
authors.lastname: Foley
authors.forename: Glen
authors.initials: G
authors.lastname: Leverson
authors.forename: Charles P
authors.initials: CP
authors.lastname: Heise
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003110:Colonic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D039702:Current Procedural Terminology; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis