title: Defining the timing and causes of death amongst patients undergoing colorectal resection in England.
abstract: OBJECTIVE
  Historically, postoperative deaths have been reported up to 30 days following surgery. There is, however, emerging evidence that deaths attributable to surgery continue to occur much later than this time frame. This aim of this study was to analyse the timing and causes of mortality following colorectal resection.
  
  
  METHODS
  Data were obtained from the Hospital Episode Statistics database with linkage to mortality data from the Office for National Statistics. Patients who underwent colorectal resection between April 2001 and February 2007 were included. Causes of death were classified into colorectal cancer (CRC), other malignancy, cardiac, respiratory, gastrointestinal, neurological and other.
  
  
  RESULTS
  During the study period 171 791 patients underwent a colorectal resection. Thirty-day mortality rates for elective procedures were 1.3, 3.5, 7.0 and 12.1% for the ≤ 65, 66-75, 76-85 and > 85 year age groups, respectively, compared with 2.2, 5.4, 9.8 and 16.7% at 90 days. For elective operations, at 30 days, 38.6% of patients who died had CRC recorded as the primary cause of death, whilst 25.4% died of cardiac causes. In the younger population undergoing a resection, deaths due to cardiac causes were significantly higher than the national average for the same age group even beyond 30 days (13.5% at 30 days, 11.1% at 90 days and 5.7% at 1 year).
  
  
  CONCLUSIONS
  This study shows that deaths attributable to colorectal surgery occur beyond the conventionally utilized 30-day period. Information presented to patients on the basis of 30-day mortality estimates is likely to underestimate the true risk of surgical intervention.
authors.affiliation: Department of Surgery, Imperial College, St Mary's Hospital, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Mamidanna
authors.affiliation: Surgical Epidemiology Trials and Outcome Centre (SETOC), St Mark's Hospital and Academic Institute, Middlesex, UK.
authors.forename: S
authors.initials: S
authors.lastname: Nachiappan
authors.affiliation: Dr Foster Unit, Department of Primary Care and Social Medicine, Imperial College, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Bottle
authors.affiliation: Dr Foster Unit, Department of Primary Care and Social Medicine, Imperial College, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Aylin
authors.affiliation: Surgical Epidemiology Trials and Outcome Centre (SETOC), St Mark's Hospital and Academic Institute, Middlesex, UK.
authors.forename: O
authors.initials: O
authors.lastname: Faiz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003082:Colectomy / Q000401:mortality; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D004739:England / Q000453:epidemiology; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors
keywords: Colorectal; cause of death; mortality; outcomes