Poor 1-year survival in elderly patients undergoing nonelective colorectal resection.

BACKGROUND

Colorectal resection in elderly patients is associated with significant morbidity and mortality, especially in an emergency setting.

OBJECTIVES

This study aims to quantify the risks associated with nonelective colorectal resection up to 1 year after surgery in elderly patients.

DESIGN

This is a population-based observational study.

SETTING

Data were obtained from the Hospital Episode Statistics database.

POPULATION: All patients aged 70 years and older who underwent a nonelective colorectal resection in an English National Health Service Trust hospital between April 2001 and March 2008 were included.

MAIN OUTCOME MEASURES: : The primary outcomes measured were 30-day in hospital mortality, 365-day mortality, unplanned readmission within 28 days of discharge, and duration of hospital stay.

RESULTS

During the study period, 36,767 nonelective colorectal resections were performed in patients aged ≥ 70 years in England. Patients were classified into 3 age groups: A (70-75 years), B (76-80 years), and C (>80 years). Thirty-day mortality was 17.0%, 23.3%, and 31.0% in groups A, B, and C (p < 0.001). The overall 30-day medical complication rate was 33.7%, and the reoperation rate was 6.3%. Cardiac and respiratory complications were significantly higher in group C (22.2% and 18.2%, p < 0.001). Mortality in Group C was 51.2% at 1-year postsurgery. Advanced age was an independent determinant of mortality in risk-adjusted regression analyses.

LIMITATIONS: This is a retrospective analysis of a prospective database. Stage of disease at presentation, severity of complications, and cause of death cannot be ascertained from this database.

CONCLUSIONS

In this population-based study, half of all English patients aged over 80 years undergoing nonelective colorectal resection died within 1 year of surgery. Further research is required to identify perioperative and postdischarge strategies that may improve survival in this vulnerable cohort.