title: Burden of emergency and non-emergency colorectal cancer surgeries in West Virginia and the USA.
abstract: OBJECTIVE
  Elective surgical resection is the curative treatment for colorectal cancer (CRC). Up to 30 % of patients present as surgical emergencies. The objective was to determine the association between presenting with an emergency condition and consequent outcomes of CRC surgery in the Appalachian state of West Virginia (WV) in comparison to the rest of the USA.
  
  
  METHODS
  Patients diagnosed with CRC who underwent a surgical procedure from January 1, 2003 to December 31, 2007 were selected, and those with a diagnosis requiring emergency surgery were identified. Primary outcome measures were length of stay (LOS), total hospital charges, and inpatient death.
  
  
  RESULTS
  Mean LOS was higher for WV. Mean charges were higher for the USA than for WV. Inpatient deaths in WV were greater than the rest of the USA. Those undergoing emergency surgery spent 51.9 % (β=0.40) more days in the hospital than those who did not. For WV, LOS was 7.6 % (β=0.07) higher than that of the US. Hospital charges for those that underwent emergency resection were 68.3 % (β=0.52) higher than those who did not. The odds of in-hospital death were 1.68 (95 % CI=1.42-1.98) times greater in WV than in the USA. Those that underwent emergency surgery had a nearly four times (OR 3.88; 95 % CI=3.74-4.03) greater chance of in-hospital death.
  
  
  CONCLUSIONS
  The study stresses the ongoing burden of emergency surgeries in many states around the nation and the need to increase awareness about CRC screening practices, especially in patients who are at increased risk of the disease.
authors.affiliation: Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV 26506-9510, USA. nshah@hsc.wvu.edu
authors.forename: Neel A
authors.initials: NA
authors.lastname: Shah
authors.forename: Joel
authors.initials: J
authors.lastname: Halverson
authors.forename: Suresh
authors.initials: S
authors.lastname: Madhavan
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000191:economics / Q000401:mortality / Q000601:surgery*; D003107:Colorectal Surgery / Q000401:mortality*; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004630:Emergencies / Q000191:economics*; D005260:Female; D017722:Hospital Charges; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D014481:United States; D014903:West Virginia