Poor 1-year survival in elderly patients undergoing nonelective colorectal resection.
BACKGROUND
Colorectal resection in elderly patients is associated with significant morbidity and mortality, especially in an emergency setting.


OBJECTIVE
This study aims to quantify the risks associated with nonelective colorectal resection up to 1 year after surgery in elderly patients.


METHODS
This is a population-based observational study.


METHODS
Data were obtained from the Hospital Episode Statistics database.


METHODS
All patients aged 70 years and older who underwent a nonelective colorectal resection in an English National Health Service Trust hospital between April 2001 and March 2008 were included.


METHODS
: The primary outcomes measured were 30-day in hospital mortality, 365-day mortality, unplanned readmission within 28 days of discharge, and duration of hospital stay.


RESULTS
During the study period, 36,767 nonelective colorectal resections were performed in patients aged ≥ 70 years in England. Patients were classified into 3 age groups: A (70-75 years), B (76-80 years), and C (>80 years). Thirty-day mortality was 17.0%, 23.3%, and 31.0% in groups A, B, and C (p < 0.001). The overall 30-day medical complication rate was 33.7%, and the reoperation rate was 6.3%. Cardiac and respiratory complications were significantly higher in group C (22.2% and 18.2%, p < 0.001). Mortality in Group C was 51.2% at 1-year postsurgery. Advanced age was an independent determinant of mortality in risk-adjusted regression analyses.


CONCLUSIONS
This is a retrospective analysis of a prospective database. Stage of disease at presentation, severity of complications, and cause of death cannot be ascertained from this database.


CONCLUSIONS
In this population-based study, half of all English patients aged over 80 years undergoing nonelective colorectal resection died within 1 year of surgery. Further research is required to identify perioperative and postdischarge strategies that may improve survival in this vulnerable cohort.
Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, United Kingdom.
Ravikrishna
R
Mamidanna
Lola
L
Eid-Arimoku
Alex M
AM
Almoudaris
Elaine M
EM
Burns
Alex
A
Bottle
Paul
P
Aylin
George B
GB
Hanna
Omar
O
Faiz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000401:mortality*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012003:Rectal Fistula / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult