title: Is colorectal surgery beyond the age of 80 still feasible with acceptable mortality? An analysis of the predictive value of CR-POSSUM and life expectancy after hospital discharge.
abstract: OBJECTIVE
  Increased morbidity and mortality could mitigate the positive effect of surgery in elderly patients undergoing colorectal resections. This retrospective study aims to describe early morbidity and mortality together with long-term survival in octogenarians and nonagenarians undergoing colorectal surgery. Predictors for in-hospital mortality are identified. The predictive value of CR-POSSUM is assessed.
  
  
  METHODS
  Data on consecutive patients 80 years old or more undergoing a colorectal resection in our centre from 2004 until 2010 were analysed.
  
  
  RESULTS
  Some 286 patients [median age 84 years; interquartile range (IQR) 81.6-86.1; 133 men, 47%] underwent a colorectal resection. Median follow-up was 32 months (IQR 14.5-51.2). Two hundred and fifty-eight patients (90%) were operated on for malignancy. Only 64 patients (22.4%) underwent a laparoscopic procedure. Overall median hospital stay was 12 days (IQR 9.0-20.0) and in-hospital mortality was 9.4%. Seventy-six per cent (n = 170) of patients could return home after discharge. The 1-year survival rate was 78.6% (95% CI 73.8-82.7). Median CR-POSSUM for in-hospital mortality was 12.6% (IQR 11.9-21.0). The concordance probability estimate was 0.668 (95% CI 0.609-0.728), reflecting a moderate predictive capacity of CR-POSSUM. Once patients had been discharged from hospital, life expectancy was similar to that of the Belgian general population.
  
  
  CONCLUSIONS
  Colorectal surgery in octogenarians and nonagenarians resulted in a considerable in-hospital mortality of about 9%. One-year mortality added an additional 12%, which is in concordance with the overall life expectancy at that age.
authors.affiliation: Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Leuven, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: de Buck van Overstraeten
authors.affiliation: Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Stijns
authors.affiliation: I-Biostat, KU Leuven - University of Leuven and Universiteit Hasselt, Leuven, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Laenen
authors.affiliation: I-Biostat, KU Leuven - University of Leuven and Universiteit Hasselt, Leuven, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Fieuws
authors.affiliation: Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Leuven, Belgium.
authors.forename: A M
authors.initials: AM
authors.lastname: Wolthuis
authors.affiliation: Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Leuven, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: D'Hoore
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000401:mortality*; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007410:Intestinal Diseases / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods / Q000401:mortality; D007902:Length of Stay / Q000706:statistics & numerical data; D008017:Life Expectancy; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate
keywords: CR-POSSUM; colorectal surgery; mortality; surgery in elderly