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Cancer Resources > Cancer News > 2009 > November

Report 90-day colectomy mortality risk, not just 30-day risk: study

Last Updated: 2009-11-25 11:00:26 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Citing only the 30-day mortality after colorectal surgery can be misleading when counseling patients about the risks of surgery, because postoperative deaths nearly double between 30 and 90 days, study findings suggest.

The 30-day mortality is the most common definition of postoperative mortality in the surgical literature and the number used most often by physicians during preoperative counseling, the authors explain.

However, based on the findings, "When possible, surgical investigators in all settings should include both 30-day and 90-day mortality rates when they report outcomes," study co-author Dr. Brendan C. Visser and associates at Palo Alto Veterans Health Care System, California, recommend in the November Archives of Surgery.

Their prospective cohort study included 186 patients (median age 67; 96% male) who underwent colorectal resection at their hospital from 2000 through 2006. Thirty-eight patients underwent emergency procedures and 148 had elective procedures.

Reasons for surgery were cancer or adenomas in 61% of cases; other indications were functional disorders, diverticulitis, inflammatory bowel disease, ischemia, volvulus and hernia.

The observed 30-day mortality rate was 4.3% overall, with rates of 1.4% and 15.8% for patients who underwent elective and emergency surgery, respectively.

Corresponding mortality rates at 90 days were 9.1% overall, 4.1% for elective surgery, and 28.9% for emergency surgery.

The investigators note that patients who died within 30 days were similar in terms of comorbidities and preoperative lab studies to those who died in the following 60 days, although the earlier deaths were generally in "sicker" patients. Many of the deaths occurred in patients for whom surgery was performed for life-threatening emergencies.

The risk factors for mortality were advanced age, low albumin level, poor renal function, high American Society of Anesthesiologists score, and emergency surgery.

For example, among patients younger than 60 years, rates were 0% and 3% at 30 and 90 days, respectively, compared with 12% and 27% for patients 80 years and older.

Patients who underwent emergency procedures had higher albumin levels and worse renal function and a higher mean American Society of Anesthesiologists score compared with those who had elective surgery. Emergency patients also stayed in the hospital longer and trended toward more complications.

Thus, Dr. Visser's team concludes: "The 90-day mortality rate proved a more accurate representation of the period within which patients died of postoperative complications."

Arch Surg 2009;144:1021-1027.

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