Colorectal cancer resection associated with more complications in elderly

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1. Between 2001 and 2010, the rates of colorectal resections fell by 7.0% per year, with an associated decrease in mortality rates of 6.6% per year for patients 65 years old and older. 

2. Despite overall improved outcomes, older patients are more likely to be urgently admitted for colorectal cancer resection, have higher rates of complications, require longer hospital stays, and have higher rates of morbidity and mortality. 

Evidence Rating Level: 2 (Good) 

Study Rundown: The proportion of elderly Americans (65 years old and older) is rapidly growing and is expected to increase by 19% over the next 15 years. Colorectal cancer (CRC) is relatively common among the elderly and represents the third leading type of cancer in the US. Surgical resection is curative in many cases of CRC, but current understanding on the effects of surgery in the elderly population is lacking.

The study found that the total number of surgical resections for CRC fell by 7.0% per year but the proportion of patients older than 65 remained constant at 64%. Patients in each older age category were found to have a greater number of comorbidities as compared to their younger counterparts, and required a longer and more expensive hospital stays. In each older age category, there was significantly higher risk-adjusted in-hospital mortality with an overall mortality rate of 3.0% across the study population. However, mortality rates among the elderly were found to decline 6.6% per year. This study represents an extensive review of CRC cases, but is limited by the inherent biases of retrospective reviews and the inability to assess follow-up outpatient data.

Click to read the study in JAMA Surgery

Relevant Reading: Surgical risk factors, morbidity, and mortality in elderly patients

In-Depth [retrospective review]: This retrospective review analyzed the trends and outcomes of surgical resection of CRC. Discharge data from all patients 45 years old and older were obtained from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS). A total of 1,043,108 patients with CRC were identified that underwent surgical resection between 2001 and 2010. In the elderly population, there was a 7.0% decrease per year in the number of surgical procedures, accounted for by a 7.6% per year decline in elective procedures and a 6.1% per year decline in urgent procedures.

Compared with patients younger than 65, all patients older than 70 had a longer mean hospital stay and total charge. Patients older than 85 required 3 additional days of in-patient care with an average cost $11,468 greater than their younger counterparts (p < 0.05). Rates of surgical complications, including acute renal failure, urinary tract infections, cardiac complications, pulmonary failure, and pneumonia, increased with greater age (p < 0.01 for all age groups compared to patients younger than 65). Overall, there was a significant, increasing trend observed in morbidity and mortality rates with age (p < 0.05). Patients younger than 65 experienced a 1.3% mortality rate, increasing among each older age group, with a 8.0% mortality rate in patients older than 85. Morbidity rates likewise increased from 27.4% to 44.9% respectively.

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