ObjectivePatients with colorectal carcinoma (CRC) with pre-existing chronic liver disease (CLD) had a significantly higher 30-day mortality after CRC surgery compared with healthy controls. This study investigated the factors associated with postoperative complications and in-hospital mortality in patients with CRC with coexisting CLD (excluding cirrhosis) who underwent colorectal surgery.DesignA retrospective, observational, population-based study.SettingData were sourced from the National Inpatient Sample database, a part of the Healthcare Cost and Utilisation Project.ParticipantsThis study analysed 7463 inpatients with CRC who underwent colorectal surgery on admission between 2005 and 2014.Primary and secondary outcome measuresThe primary endpoint of this study was the prevalence of postoperative complications, and the secondary endpoint was in-hospital mortality.ResultsIn the CLD group, 36.27% of patients had chronic hepatitis C, 28.36% had non-alcoholic fatty liver disease and 31.19% had other types of CLD. The median hospital stay was 7.0 (5.0–10.0) days in patients with no postoperative complications vs 17.0 (10.0–26.0) days, 8.0 (6.0–12.0) days, 8.0 (6.0–17.0) days, 9.0 (8.0–14.0) days and 10.5 (7.0–17.0) days for patients with postoperative infection, postoperative bleeding, cardiac arrest/heart failure, respiratory complications and digestive complications, respectively (all p<0.05). The presence of CLD was significantly associated with higher risk of postoperative bleeding (adjusted OR (aOR)=1.64, 95% CI 1.15 to 2.34, p=0.007). The presence of CLD (aOR=1.98, 95% CI 1.39 to 2.82, p<0.001) and length of hospital stay (aOR=1.06, 95% CI 1.04 to 1.08, p<0.001) were significantly associated with higher risk of in-hospital mortality. However, hyperlipidaemia was associated with a significantly lower risk of mortality (aOR=0.46, 95% CI 0.28 to 0.75, p=0.002).ConclusionsPostoperative complications prolonged the length of hospital stay. The presence of CLD and hyperlipidaemia were important factors impacting postoperative complications and in-hospital mortality in patients with CRC with underlying CLD.
Population-Based Study of Relationships Between Hospital Volume of Prostatectomies, Patient Outcomes, and Length of Hospital Stay
