title: Preoperative functional health status may predict outcomes after elective colorectal surgery for malignancy.
abstract: BACKGROUND
  Several studies suggest that preoperative functional health status (FHS) affects postoperative outcomes after ventral hernia repair, hepatic resections, and infrainguinal by-pass surgery. However, little is known about the proficiency of FHS in terms of preoperative outcome prediction of patients who undergo elective resection for colorectal cancer.
  
  
  METHODS
  All patients who underwent elective colorectal resections for malignancy between 2005 and 2009 were identified from the American College of Surgeons National Surgical Quality Improvement Program. We classified patients into three groups according to their preoperative FHS: independent (IND), partially dependent (PDN), and totally dependent (TDN). Multivariable techniques were used to evaluate the impact of FHS on postoperative outcomes. Outcomes of laparoscopic and open procedures in patients with dependent FHS were also compared.
  
  
  RESULTS
  In total, 25,591 patients included (94.2% IND, 5.1% PDN, and 0.71% TDN). Surgical, infectious, pulmonary, cardiovascular, renal, neurological complications, and mortality rate showed a linear progression that paralleled a decline in preoperative FHS of the patients (p < 0.05). Laparoscopic technique was associated with better outcomes in terms of reduced length of total hospital stay, decreased infectious complication rate, and mortality with comparable operating time in patients with dependent (PDN and TDN) FHS (p < 0.05).
  
  
  CONCLUSIONS
  Functional health status may predict postoperative outcomes after colorectal cancer surgery. A detailed preoperative evaluation, providing an optimization period before surgery if necessary, and increased utilization of laparoscopic technique may improve outcomes after elective colorectal resections for malignancy in patients who are partially or TDN.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors.forename: Ozgen
authors.initials: O
authors.lastname: Isik
authors.forename: Nuri
authors.initials: N
authors.lastname: Okkabaz
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hammel
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Emre
authors.initials: E
authors.lastname: Gorgun
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D057234:Preoperative Period; D011379:Prognosis; D011788:Quality of Life