title: Reoperation after colorectal surgery is an independent predictor of the 1-year mortality rate.
abstract: BACKGROUND
  Comparative evaluation of surgical quality among hospitals must improve outcome and efficiency, and reduce medical costs. Reoperation after colorectal surgery is a consequence of surgical complications and therefore considered a quality-of-care indicator. With respect to the mortality rate, the 1-year mortality may be a more meaningful figure than in-hospital mortality, because it also reflects the impact of surgical complications beyond discharge.
  
  
  OBJECTIVE
  The aim of our study was to evaluate the 1-year mortality after colorectal surgery and to identify predicting factors.
  
  
  METHODS
  This study was a retrospective analysis from our colorectal surgery database.
  
  
  METHODS
  All patients who underwent elective colorectal surgery from 2005 to 2008 were included.
  
  
  METHODS
  Both univariate and multivariate analysis were performed to identify predicting factors. The following variables were analyzed: age, operative risk according to the ASA class, Charlson-Age Comorbidity Index, indication for and type of resection, primary anastomosis, tumor staging, anastomotic leakage, and reoperation.
  
  
  RESULTS
  For 743 consecutive patients, the 1-year mortality rate was 6.9%. Patients were operated on mainly because of colorectal cancer (n = 537; 72%). The rate of reoperation and in-hospital mortality was 12.8% and 2.4%. Univariate survival analysis demonstrated that ASA class, age, Charlson-Age Comorbidity Index, reoperation, and stage of disease were independent predictors of 1-year mortality. Multivariate analysis showed that ASA class (P = .020; HR 1.69), age (P = .015; HR 2.08) and reoperation (P = .001; HR 2.72) are directly correlated with 1-year mortality.
  
  
  CONCLUSIONS
  Both patients with benign diseases and colorectal cancer are included. Furthermore, no clear guidelines on whether to perform a reoperation were available.
  
  
  CONCLUSIONS
  One-year mortality after colorectal surgery is independently predicted by ASA class, age, and reoperation. Our results underline the value of the 1-year mortality rate and the reoperation rate as parameters for quality assessment in colorectal surgery.
authors: Department of Surgery, Isala Clinics, Zwolle, Netherlands. e.van.westreenen@antoniusziekenhuis.nl
authors: Henderik L
authors: HL
authors: van Westreenen
authors: Frank F
authors: FF
authors: Ijpma
authors: Kevin P
authors: KP
authors: Wevers
authors: Hamid
authors: H
authors: Afzali
authors: Gijsbert A
authors: GA
authors: Patijn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000401:mortality*; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012086:Reoperation / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate