title: Association of Comorbidity with Anastomotic Leak, 30-day Mortality, and Length of Stay in Elective Surgery for Colonic Cancer: A Nationwide Cohort Study.
abstract: BACKGROUND
  Comorbidity has a negative influence on the long-term prognosis in patients with colorectal cancer, whereas its impact on the postoperative course is less clear.
  
  
  OBJECTIVE
  The aim of this study was to investigate the influence of comorbidity on anastomotic leak and short-term outcomes after resection for colonic cancer.
  
  
  METHODS
  This is a retrospective nationwide cohort study
  
  
  METHODS
  : Data were obtained from the Danish Colorectal Cancer Group and the National Patient Registry.
  
  
  METHODS
  Patients with colonic cancer undergoing elective resection between 2001 and 2008 were selected.
  
  
  METHODS
  The primary outcome was the ability of comorbidity to predict anastomotic leak. Secondary outcomes were 30-day mortality and length of stay. Comorbidity was assessed by the Charlson Comorbidity Index. Multivariable logistic regression and receiver operating characteristics curves were used to adjust for confounding.
  
  
  RESULTS
  The rate of anastomotic leak was 535/8597 (6.2%). The mean (95% CI) Charlson score was 0.83 (0.72-0.94) and 0.63 (0.61-0.66) for patients with and without anastomotic leak, p < 0.001. The Charlson score, as assessed in the multivariable analysis (adjusted OR, 1.07; 95% CI, 0.99-1.15; p = 0.077) and by receiver operating characteristics curves (area under the curve = 0.548), failed to predict anastomotic leak. Thirty-day mortality was 425/8587 (4.9%). In patients with anastomotic leakage, a Charlson score of ≥ 2 was associated with increased mortality in comparison with a Charlson score of <2 (adjusted HR, 1.58; 95% CI, 1.00-2.51; p = 0.047). Mean length of stay was 8.7 days (95% CI, 8.4-9.2 days) for patients without an anastomotic leak in comparison with 23.3 days (95% CI, 21.5-25.1 days) for patients with anastomotic leak and 25.5 days (95% CI, 21.7-29.3 days) in patients with anastomotic leak and a Charlson score of >2, p < 0.001.
  
  
  CONCLUSIONS
  This study is limited by the accuracy of the coding used to generate the Charlson Comorbidity Index and the retrospective study design.
  
  
  CONCLUSIONS
  Comorbidity failed to predict anastomotic leak, but it was associated with an inferior short-term outcome in patients with this surgical complication.
authors.affiliation: 1 Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark 2 Danish Colorectal Cancer Group, Copenhagen, Denmark.
authors.forename: Peter-Martin
authors.initials: PM
authors.lastname: Krarup
authors.forename: Andreas
authors.initials: A
authors.lastname: Nordholm-Carstensen
authors.forename: Lars Nannestad
authors.initials: LN
authors.lastname: Jorgensen
authors.forename: Henrik
authors.initials: H
authors.lastname: Harling
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000401:mortality* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000401:mortality*; D015331:Cohort Studies; D003082:Colectomy; D003110:Colonic Neoplasms / Q000150:complications* / Q000401:mortality* / Q000601:surgery; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012042:Registries; D012307:Risk Factors