Comparing Emergent and Elective Colectomy Outcomes in Elderly Patients: A NSQIP Study

Introduction. With the increasing prevalence of colorectal cancer (CRC) worldwide, especially in the elderly, and the variability between physiological and chronological age and its impact on functional status, acute symptoms leading to emergent surgery due to colorectal malignancy may lead to increased morbidity and mortality. The aim of this study is to identify the outcome differences of elective vs. emergent open colectomy in patients above 80 years. Methods. The National Surgical Quality Improvement Program (NSQIP) database was reviewed from 2010 to 2014 for open colectomy based on CPT codes. Comparison between groups was done based on the clinical context at presentation as elective or emergent surgery. Data were analyzed using SAS. Results. Elective colectomies were performed in 8289 (70.8%) vs. emergent colectomies in 3409 (29.1%). Emergent colectomy patients had higher American Society of Anesthesiologists (ASA) preoperative classification III-IV, 1429 (42.0%) and 224 (6.6%), vs. 1238 (14.9%) and 21 (0.2%) in elective colectomy patients p < 0.0001 . Emergent colectomy patients had more comorbidities such as chronic obstructive pulmonary disorder (493 (14.5%) vs. 796 (9.6%)), congestive heart failure (206 (6.0%) vs. 310 (3.8%)), dialysis (106 (3.1%) vs. 56 (0.7%)), and acute renal failure (166 (4.9%) vs. 46 (0.6%)) p < 0.0001 , respectively. Postoperative morbidity and mortality were significantly higher in emergent colectomy (1651 (48.4%) and 872 (25.6%)) vs. elective colectomy (1859 (22.4%) and 567 (6.8%)) p < 0.0001 , respectively. Conclusion. Emergent open colectomy in elderly patients carries a higher risk of morbidity and mortality when compared to elective open colectomy with risk factors being higher ASA classification and more comorbidities.

Correction to: Association of laparoscopic colectomy versus open colectomy on the long‑term health‑related quality of life of colon cancer survivors

A correction to this paper has been published: https://doi.org/10.1007/s00464-021-08557-0

Complications and postoperative ileus in laparoscopic versus open colectomy: A retrospective cohort study

Background: Postoperative complications are a major concern after colorectal surgery, and can lead to an increased burden on patients and the healthcare system. Complications include postoperative ileus (POI) and prolonged postoperative ileus (PPOI). There are well-established risk factors and potential modifiable risk factors that affect the incidence of POI and PPOI, including invasive techniques, operative difficulty, perioperative blood loss, and delayed mobilization. We compared the incidence of POI, PPOI, and other postoperative complications between laparoscopic colectomy and open colectomy. Methods: This retrospective review investigates 120 patients who underwent either laparoscopic or open colectomy in King AbdulAziz University Hospital in Jeddah, Saudi Arabia, between January 2016 and June 2019. Data were collected from patients’ electronic medical records. Patients were classified into laparoscopic and open colectomy groups. The main outcomes of interest were POI, PPOI and the overall complication rate. These outcomes were calculated and compared between the two groups. Results: The overall incidence of POI and PPOI was 4.2% and 15%, respectively. There was a higher incidence of POI in the laparoscopic approach group (7.2% vs. 1.5%, P=0.03); however, the incidence of PPOI was higher in the open approach group (20% vs. 9.1%, P=0.03). The open surgery group showed a higher rate of overall complications (P=0.001). The mean estimated blood loss was lower in the laparoscopy group (139.09±145.83 vs. 343.85±307.78 mL; P<0.001). Significant earlier mobilization was observed in the laparoscopic group (3.12±1.77 vs. 5.39±3.48 days; P<0.001). Conclusion: The incidence of PPOI was significantly different depending on the surgical approach; however, the laparoscopy group tolerated regular diet earlier and had better outcomes regarding postoperative complications. The laparoscopic approach was associated with earlier ambulation and was more cost-effective based on the length of the hospital stay. Further randomized studies are required to confirm superiority of the laparoscopic approach in terms of postoperative recovery.

The Impact of Comorbid Diabetes on Short-Term Postoperative Outcomes in Stage I/II Colon Cancer Patients Undergoing Open Colectomy

Purpose. This study aimed at evaluating the impact of comorbid diabetes on short-term postoperative outcomes in patients with stage I/II colon cancer after open colectomy. Methods. The data were extracted from the National Inpatient Sample database (2005-2010). Short-term surgical outcomes included in-hospital mortality, postoperative complications, and hospital length of stay. Results. A total of 49,064 stage I/II colon cancer patients undergoing open surgery were included, with a mean age of 70.35 years. Of them, 21.94% had comorbid diabetes. Multivariable analyses revealed that comorbid diabetes was significantly associated with a lower risk of in-hospital mortality and postoperative complications. Compared to patients without diabetes, patients with uncomplicated diabetes had lower percentages of in-hospital mortality and postoperative complications, but patients with complicated diabetes had a higher percentage of postoperative complications. In addition, patients with diabetes only, but not patients with diabetes and hypertension only, had a lower percentage of in-hospital mortality than patients without any comorbidity. Conclusion. The present results suggested the protective effects of uncomplicated diabetes on short-term surgical outcomes in stage I/II colon cancer patients after open colectomy. Further studies are warranted to confirm these unexpected findings and investigate the possible underlying mechanisms.