Determination of Two Specific Risk Factors in Maturation and Function of Anastomoses after Large Bowel Resection in Adults

Background Frailty has been recognized as an independent risk factor for inferior outcomes, but its effect on emergency general surgery (EGS) is understudied. Objective The purpose of the present study was to define the impact of frailty on risk-adjusted mortality, non-home discharge, and readmission following EGS operations. Methods Adults undergoing appendectomy, cholecystectomy, small bowel resection, large bowel resection, repair of perforated ulcer, or laparotomy within two days of an urgent admission were identified in the 2016–2017 Nationwide Readmissions Database. Frailty was defined using diagnosis codes corresponding to the Johns Hopkins Adjusted Clinical Groups frailty indicator. Multivariable regression was used to study in-hospital mortality and non-home discharge by operation, and Kaplan Meier analysis to study freedom from unplanned readmission at up to 90-days follow-up. Results Among 655,817 patients, 11.9% were considered frail. Frail patients most commonly underwent large bowel resection (37.3%) and cholecystectomy (29.2%). After adjustment, frail patients had higher mortality rates for all operations compared to nonfrail, including those most commonly performed (11.9% [95% CI 11.4–12.5%] vs 6.0% [95% CI 5.8–6.3%] for large bowel resection; 2.3% [95% CI 2.0–2.6%] vs 0.2% [95% CI 0.2–0.2%] for cholecystectomy). Adjusted non-home discharge rates were higher for frail compared to nonfrail patients following all operations, including large bowel resection (68.1% [95% CI 67.1–69.0%] vs 25.9% [95% CI 25.2–26.5%]) and cholecystectomy (33.7% [95% CI 32.7–34.7%] vs 2.9% [95% CI 2.8–3.0%]). Adjusted hospitalization costs were nearly twice as high for frail patients. On Kaplan-Meier analysis, frail patients had greater unplanned readmissions (log rank P<0.001), with 1 in 4 rehospitalized within 90 days. Conclusions Frail patients have inferior clinical outcomes and greater resource use following EGS, with the greatest absolute differences following complex operations. Simple frailty assessments may inform expectations, identify patients at risk of poor outcomes, and guide the need for more intensive postoperative care.

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GLP-1 Release in Man after Lower Large Bowel Resection or Intrarectal Glucose Administration

Digestion ◽

10.1159/000007577 ◽

1998 ◽

Vol 59 (6) ◽

pp. 689-695 ◽

Cited By ~ 9

Author(s):

H. Printz ◽

S. Reiter ◽

N. Samadi ◽

S. Ebrahimsade ◽

R. Kirchner ◽

...

Keyword(s):

Large Bowel ◽

Bowel Resection ◽

Glucose Administration ◽

Large Bowel Resection

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Morbidity and mortality following major large bowel resection for colorectal cancer detected by a population-based screening program

Journal of Medical Screening ◽

10.1177/0969141320957361 ◽

2020 ◽

pp. 096914132095736

Author(s):

Lawrence F Paszat ◽

Rinku Sutradhar ◽

Elyse Corn ◽

Jin Luo ◽

Nancy N Baxter ◽

...

Keyword(s):

Colorectal Cancer ◽

Large Bowel ◽

Bowel Resection ◽

Screening Program ◽

Occult Blood ◽

Population Based ◽

Fecal Occult Blood ◽

Operative Complications ◽

Large Bowel Resection ◽

Post Operative Complications

Background and aims In 2008, Ontario initiated a population-based colorectal screening program using guaiac fecal occult blood testing. This work was undertaken to fill a major gap in knowledge by estimating serious post-operative complications and mortality following major large bowel resection of colorectal cancer detected by a population-based screening program. Methods We identified persons with a first positive fecal occult blood result between 2008 and 2016, at the age of 50–74 years, who underwent a colonoscopy within 6 months, and proceeded to major large bowel resection for colon cancer within 6 months or rectosigmoid/rectal cancer within 12 months, and identified an unscreened cohort of resected cases diagnosed during the same years at the age of 50–74 years. We identified serious postoperative complications and readmissions ≤30 days following resection, and postoperative mortality ≤30 days, and between 31 and 90 days among the screen-detected and the unscreened cohorts. Results Serious post-operative complications or readmissions within 30 days were observed among 1476/4999 (29.5%) cases in the screen-detected cohort, and among 3060/8848 (34.6%) unscreened cases. Mortality within 30 days was 43/4999 (0.9%) among the screen-detected cohort, and 208/8848 (2.4%) among the unscreened cohort. Among 30 day survivors, mortality between 31 and 90 days was 28/4956 (0.6%) and 111/8640 (1.3%), respectively. Conclusion Serious post-operative complications, readmissions, and mortality may be more common following major large bowel resection for colorectal cancer between the ages of 50 and 74 among unscreened compared to screen-detected cases.

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Predictive and Prognostic Implication of Bowel Resections During Primary Cytoreductive Surgery in Advanced Epithelial Ovarian Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001369 ◽

2018 ◽

Vol 28 (9) ◽

pp. 1664-1671 ◽

Cited By ~ 7

Author(s):

Thomas Bartl ◽

Richard Schwameis ◽

Anton Stift ◽

Thomas Bachleitner-Hofmann ◽

Alexander Reinthaller ◽

...

Keyword(s):

Risk Factors ◽

Ovarian Cancer ◽

Overall Survival ◽

Anastomotic Leakage ◽

Cytoreductive Surgery ◽

Large Bowel ◽

Bowel Resection ◽

Prognostic Implication ◽

Rectosigmoid Resection ◽

Advanced Epithelial Ovarian Cancer

ObjectivesThe aims of this study were to assess anastomotic leakage (AL) rate and risk factors for AL in patients with advanced epithelial ovarian cancer (EOC) undergoing cytoreductive surgery including bowel resections and to evaluate the prognostic implication of AL.MethodsData of 350 consecutive patients with International Federation of Gynecology and Obstetrics EOC stage IIB–IV who underwent cytoreductive surgery at the Department of General Gynecology and Gynecologic Oncology of the General Hospital of Vienna between 2003 and 2017 were collected. Within this cohort, 192 patients (54.9%) underwent at least 1 bowel resection and were further analyzed. Preoperative risk factors for AL were computed using logistic regression models. Prognostic factors for overall survival were evaluated by using log-rank tests and multivariable Cox regression model.ResultsOverall, the AL rate was 4.7% for patients with advanced EOC undergoing cytoreductive surgery with at least 1 bowel resection, including patients with multiple large bowel resections. The AL rate for patients with isolated rectosigmoid resection was 1.9%. In univariate analysis, the number of anastomoses per surgery (P= 0.04) was associated with the occurrence of AL. In multivariable analysis, rectosigmoid resection with additional large bowel resection was associated with a higher risk of AL compared with isolated rectosigmoid resection (P= 0.046; odds ratio, 7.23 [95% confidence interval, 1.04–50.39]). Anastomotic leakage was associated with decreased overall survival (P= 0.04) in univariate but not in multivariable survival analysis.ConclusionsAnastomotic leakage rate after rectosigmoid resection in advanced EOC is acceptably low and outweighs increased perioperative risks when performed in a high-volume institution. Nonetheless, the occurrence of AL is a severe adverse event, which even seems to negatively affect patients’ overall prognosis. As no factor could be identified to clearly predict AL, extensive procedures comprising multiple bowel resections, should be avoided particularly when complete resection cannot be achieved.

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