title: Predictors of short-term postoperative survival after elective colectomy in colon cancer patients ≥ 80 years of age.
abstract: BACKGROUND
  Individuals ≥ 80 years of age represent an increasing proportion of colon cancer diagnoses. Selecting these patients for elective surgery is challenging because of diminished overall health, functional decline, and limited data to guide decisions. The objective was to identify overall health measures that are predictive of poor survival after elective surgery in these oldest-old colon cancer patients.
  
  
  METHODS
  Medicare beneficiaries ≥ 80 years who underwent elective colectomy for stage I-III colon cancer from 1992-2005 were identified from the Surveillance, Epidemiology and End Results(SEER)-Medicare database. Kaplan-Meier survival analysis determined 90-day and 1-year overall survival. Multivariable logistic regression assessed factors associated with short-term postoperative survival.
  
  
  RESULTS
  Overall survival for the 12,979 oldest-old patients undergoing elective colectomy for colon cancer was 93.4 and 85.7 %, at 90 days and 1 year. Older age, male gender, frailty, increased hospitalizations in prior year, and dementia were most strongly associated with decreased survival. In addition, AJCC stage III (vs stage I) disease and widowed (vs married) were highly associated with decreased survival at 1 year. Although only 4.4 % of patients were considered frail, this had the strongest association with mortality, with an odds ratio of 8.4 (95 % confidence interval, 6.4-11.1).
  
  
  CONCLUSIONS
  Although most oldest-old colon cancer patients do well after elective colectomy, a significant proportion (6.6 %) die by postoperative day 90 and frailty is the strongest predictor. The ability to identify frailty through billing claims is intriguing and suggests the potential to prospectively identify, through the electronic medical record, patients at highest risk of decreased survival.
authors.affiliation: Department of Surgery, UW Madison School of Medicine and Public Health, Madison, Wisconsin, USA. neuman@surgery.wisc.edu
authors.forename: Heather B
authors.initials: HB
authors.lastname: Neuman
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Weiss
authors.forename: Glen
authors.initials: G
authors.lastname: Leverson
authors.forename: Erin S
authors.initials: ES
authors.lastname: O'Connor
authors.forename: David Y
authors.initials: DY
authors.lastname: Greenblatt
authors.forename: Noelle K
authors.initials: NK
authors.lastname: Loconte
authors.forename: Caprice C
authors.initials: CC
authors.lastname: Greenberg
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Smith
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D003110:Colonic Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D003657:Decision Making; D003704:Dementia / Q000150:complications; D017558:Elective Surgical Procedures; D005260:Female; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D015999:Multivariate Analysis; D018579:Patient Selection; D018426:SEER Program