An analysis of mortality in patients with colorectal carcinoma undergoing elective versus emergent colectomies

Author(s):
Shalwa Mohidul; Keely Muertos; Jason Sciarretta; John Davis

Background:

The purpose of this study was to examine the differences in outcomes of emergent and non-emergent colectomies in patients with colorectal carcinoma (CRC) using data collected by the American College of Surgeons National Surgery Quality Initiative Program (ACS-NSQIP).

Hypothesis:

We hypothesize that there are independent risk factors that contribute to increased mortality in patients with colorectal cancer who require emergent colectomies.

Methods:

The ACS-NSQIP database was queried for all CRC cases who underwent colectomies in 2016, and a total of 14,392 patients were identified. There were a total of 129 cases who subsequently expired, of which 90 cases were non-emergent and 39 cases were emergent. These 129 cases were reviewed for the presence of risk factors associated with postoperative mortality. Continuous variables were compared using a Wilcoxon-Mann-Whitney U-test while categorical variables were compared using Χ² or Fisher’s exact, as appropriate. Continuous data is expressed as mean ± standard deviation (X±SD). All p values of less than 0.05 were considered significant.

Results:

Emergent colectomy cases were 7.3 times more likely to expire (39 patients, 4.66%, OR: 7.31, 95% confidence interval: 4.99 – 10.72) compared to non-emergent (90 patients, 0.66%) colectomy cases (p value < 0.001). The 39 patients undergoing emergent colectomies had an overall shorter operative time (100.0 ±57.7 minutes, p value <0.001), compared to those undergoing non-emergent colectomies (179.5 ± 111.1 minutes). The emergent colectomies cohort had more statistically significant predisposing risk factors (6 versus 1). These risk factors, present at the time of surgery, include: ventilator dependent (p value of 0.030), disseminated cancer (p value of 0.002), history of renal failure (p value of 0.030), sepsis (p value <0.001), septic shock (p value < 0.001), and a class 4 dirty/contaminated wound (p value < 0.001).

Conclusions:

Emergent surgery is known to have poorer overall outcomes. A history of ventilator dependence, disseminated cancer, renal failure, and evidence of sepsis at the time of presentation, should be considered as significant risk factors in patients with a history of CRC, who require colectomies. Optimizing these factors prior to the time of surgery may result in improved outcomes, and overall decreased mortality rates.