title: Nonelective colon cancer resection: A continued public health concern.
abstract: Little is known regarding recent trends in the rate of nonelective colon cancer resection in the United States and its impact on both short-term and long-term outcomes.
  
  
  
  The New York State Cancer Registry and Statewide Planning & Research Cooperative System identified stage I-III colon cancer resections from 2004-2011. Propensity-matched analyses assessed differences in short-term adverse outcomes and 5-year disease-specific and overall survival between elective and nonelective colon cancer operations. Further analyses assessed the association among patient, surgeon, and hospital-level factors and outcomes within the nonelective operation group.
  
  
  
  Among 26,420 patients, 26.5% underwent nonelective operations. There was no significant change in the rate of nonelective resection from 2004-2011 (P = .25). Nonelective operations were independently associated with greater odds of 30-day mortality (odds ratio [OR] = 3.42, 95% confidence interval [CI] = 2.87-4.06), stoma creation (OR = 4.49, 95% CI = 3.95-5.09), intensive care unit admission (OR = 1.68, 95% CI = 1.53-1.84), complications (OR = 2.34, 95% CI = 2.18-2.52), and discharge to another health care facility (OR = 2.46, 95% CI = 2.26-2.68), longer duration of stay (incidence rate ratio = 1.79, 95% CI = 1.76-1.83), and worse disease-specific (hazard ratio = 1.74, 95% CI = 1.61-1.88) and overall survival (hazard ratio = 1.64, 95% CI = 1.55-1.75). Other than an association among high-volume surgeons, adequate lymph node yield, and receipt of adjuvant chemotherapy and lower mortality, no other potentially modifiable factors were associated with survival after nonelective operations.
  
  
  
  Nonelective colon cancer resection remains a concerning public health issue with >25% of cases being performed on a nonelective basis and an independent association with poor short-term and long-term survival compared with elective operations. Given that few potentially modifiable factors appear to have an impact on survival after nonelective operations, these findings highlight the importance of adherence to colon cancer screening guidelines to limit the number of nonelective colon cancer resections.
authors.affiliation: Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY. Electronic address: christopher_aquina@urmc.rochester.edu.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Aquina
authors.affiliation: Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY.
authors.forename: Adan Z
authors.initials: AZ
authors.lastname: Becerra
authors.affiliation: Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY.
authors.forename: Zhaomin
authors.initials: Z
authors.lastname: Xu
authors.affiliation: New York State Cancer Registry, New York State Department of Health, Albany, NY.
authors.forename: Francis P
authors.initials: FP
authors.lastname: Boscoe
authors.affiliation: New York State Cancer Registry, New York State Department of Health, Albany, NY.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Schymura
authors.affiliation: Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY.
authors.forename: Katia
authors.initials: K
authors.lastname: Noyes
authors.affiliation: Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY; Center for Colon and Rectal Surgery, Florida Hospital Medical Group, University of Central Florida College of Medicine, Orlando, FL.
authors.forename: John R T
authors.initials: JRT
authors.lastname: Monson
authors.affiliation: Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY.
authors.forename: Fergal J
authors.initials: FJ
authors.lastname: Fleming
mesh_terms: D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D003082:Colectomy / Q000379:methods* / Q000401:mortality*; D003110:Colonic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016001:Confidence Intervals; D016208:Databases, Factual; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures / Q000379:methods / Q000401:mortality; D004638:Emergency Treatment / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011634:Public Health; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis