Age at Surgery Predicts Colorectal Cancer Surgery Mortality, Morbidity

The aging population is a concern for colorectal cancer surgery care

medwireNews: Care of patients after colorectal cancer (CRC) surgery should be re-evaluated in the context of an aging population, say US researchers who highlight the impact of increasing age on the risk of morbidity and mortality after resection.

Analysis of data for 1,043,108 patients who underwent CRC surgery between 2001 and 2010 in the USA revealed that 63.8% of patients were aged 65 years or older and 22.6% of patients were aged 80 years or older.

Overall mortality fell by an average of 6.6% over the 10-year study, with the greatest fall of 9.1% noted for patients aged 85 years or above, report Michael Stamos, from the University of California in Irvine, and co-authors.

But age remained a significant predictor of in-hospital mortality and morbidity after adjusting for confounding factors such as comorbidity, hospital characteristics, procedure and admission diagnosis.

Compared with patients aged 45 to 64 years, their counterparts aged 65 to 69 years were a significant 1.32 times more likely to die in hospital. The adjusted odds ratios (ORs) continued to rise with increasing age to 2.02 for patients aged 70 to 74 years, 2.51 for patients aged 75 to 79 years and 3.15 for those aged 80 to 84 years, peaking at an OR of 4.72 for patients aged 85 years or older.

Although the rate of major CRC surgery complications, such as anastomotic leak or intestinal fistula, did not significantly change with increasing age, the risk of cardiac, renal or respiratory complications and urinary tract infections significantly and positively correlated with patient age.

Thus, the adjusted ORs for morbidity were 1.25 for patients aged 65 to 69 years, 1.40 for patients aged 70 to 74 years, 1.54 for those aged 75 to 79 years, 1.68 for patients aged 80 to 84 years and 1.96 for older individuals, compared with patients aged 45 to 64 years.

As expected, hospital costs and length of hospital stay increased with age, as did the likelihood of discharge to a short-term care facility, say the researchers, who believe social factors may also impact discharge patterns.

“[T]he elderly require vigilant postoperative treatment and anticipation of their social needs, which have to be factored into their preoperative counseling and postoperative planning,” write Michael Stamos et al.

In addition, almost half (46.0%) of elective laparoscopies were performed on patients aged less than 65 years, with just 14.1% reported in patients aged 80 years or older, despite laparoscopy having been found to be safe for high-risk patients. This trend may be due to older patients being more likely to be treated in non-teaching hospitals, the researchers comment.

The team concludes in JAMA Surgery: “[W]e believe our data not only supply the modern surgeon with the tools to counsel patients but also reveal a demand for a reevaluation of current care patterns, reinforcing the need for future studies to account for the changing population landscape in the United States.”


Mafari M, Jarafi F, Halabi J, et al. Colorectal cancer resecton in the aging US population. A trend toward decreasing rates and improved outcomes. JAMA Surg 2014; Advance online publication 9 April. doi:10.1001/jamasurg.2013.4930

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