title: Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients.
abstract: OBJECTIVE
  We sought to characterize the effect of postoperative complications on long-term survival after colorectal cancer (CRC) resection.
  
  
  BACKGROUND
  The impact of early morbidity on long-term survival after curative-intent CRC surgery remains controversial.
  
  
  METHODS
  The Veterans Affairs Surgical Quality Improvement Program and Central Cancer Registry databases were linked to acquire perioperative and cancer-specific data for 12,075 patients undergoing resection for nonmetastatic CRC (1999-2009). Patients were categorized by presence of any complication within 30 days and by type of complication (noninfectious vs infectious). Univariate and multivariate survival analyses adjusted for patient, disease, and treatment factors were performed, excluding early deaths (<90 days). Subset analysis was performed to determine the specific impact of severe postoperative infections.
  
  
  RESULTS
  The overall morbidity and infectious complication rates were 27.8% and 22.5%, respectively. Patients with noninfectious postoperative complications were older, had lower preoperative serum albumin, had worse functional status, and had higher American Society of Anesthesiologists scores than patients with infectious complications and without complications (all P < 0.001). The presence of any complication was independently associated with decreased long-term survival [hazard ratio, 1.24; 95% confidence interval (1.15-1.34)]. Multivariate analysis by complication type demonstrated increased risk only with infectious complications [hazard ratio, 1.31; 95% confidence interval (1.21-1.42)]. Subset analysis demonstrated this effect predominantly in patients with severe infections [hazard ratio, 1.41; 95% confidence interval (1.15-1.73)].
  
  
  CONCLUSIONS
  The presence of postoperative complications after CRC resection is associated with decreased long-term survival, independent of patient, disease, and treatment factors. The impact on long-term outcome is primarily driven by infectious complications, particularly severe postoperative infections.
authors.affiliation: *Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX †Department of Surgery, Division of General Surgery and Surgical Oncology, Baylor College of Medicine, Houston, TX ‡Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety (iQuest), Houston, TX; and §Department of Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Avo
authors.initials: A
authors.lastname: Artinyan
authors.forename: Sonia T
authors.initials: ST
authors.lastname: Orcutt
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Anaya
authors.forename: Peter
authors.initials: P
authors.lastname: Richardson
authors.forename: G John
authors.initials: GJ
authors.lastname: Chen
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007239:Infections / Q000401:mortality*; D008297:Male; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate