Mortality Risk Stratification in Emergency Surgery for Obstructive Colon Cancer—External Validation of International Scores, American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (SRC), and the Dedicated Score of French Surgical Association (AFC/OCC S... (original) (raw)
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ABCD, 2022
BACKGROUND: Occlusion is the most common complication of colon cancer. Surgical treatment is associated with the highest morbidity and mortality rate (10-27%) and has the worst prognosis. It is necessary for immediate management, avoiding colic perforation and peritonitis. The increase in mortality in emergency colon cancer surgery is multifactorial. AIMS: The aim of this study was to identify the risk factors for early postoperative mortality that highlights the therapeutic strategy in the management of obstructive colon cancer. METHODS: A retrospective study was performed on patients admitted from 2008 to 2020 at the Department of General Surgery due to obstructive colon cancer and operated on as an emergency (within 24 h of admission). RESULTS: In all, 118 patients with colon cancer were operated, and the early postoperative mortality was 10.2%. The univariate analysis highlighted that the American Society of Anesthesiology score III or IV, perforation tumor, one postoperative complication, and two simultaneous postoperative complications were considered significant risk factors for early postoperative mortality after emergent surgery. Multivariate analysis showed that only tumor perforation and the occurrence of two postoperative complications were significant risk factors. CONCLUSION: This study showed that postoperative complication is the leading cause of early postoperative mortality after emergency surgery for obstructive colon cancer. Optimizing the postoperative management of these higher risk patients is still necessary and may reduce the mortality rate.
Sao Paulo Medical Journal
Despite advances in surgical approaches, emergency colorectal surgery has high mortality and morbidity. 1 The mortality rates after emergency colorectal surgery range from 2.3% to 80%. 2,3 This wide range is secondary to the expertise of the surgical center and the patients' comorbidities. Colorectal emergency situations such as diverticulitis, trauma and ischemia may be related to either benign or malignant etiologies. 3 Colorectal cancer is the reason behind colorectal emergencies in 85% of the cases, with colonic obstruction in 11%-43% of all presentations. 4 Perforation and obstruction of the colon and rectum are important factors leading to postoperative mortality in patients with emergency admissions. 5 The comorbidities that cannot be managed adequately in emergency colorectal surgery and which cause highest mortality are cardiopulmonary, renal and thromboembolic diseases. 6 Scoring systems for use in predicting postoperative mortality after surgical procedures already exist. The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and the Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (p-POSSUM) are two examples of such scoring systems. Both of these use physiological and operative parameters. 7 Through use of these systems, it was realized that advanced age and high frequency of emergency procedures within colorectal surgery made these two scores inadequate. Thus, after omission of certain parameters, a new model was devised for colorectal surgery, which was named the colorectal-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (cr-POSSUM).
Predicting Postoperative Mortality in Patients Undergoing Colorectal Surgery
World Journal of Surgery, 2006
Well-known and suitable instruments for surgical audit are the POSSUM and P-POSSUM scoring systems. But these scores have not been well validated across the countries. The objective of the present study was to assess the predictive value of scores for colorectal surgery in France. Patients operated on for colorectal malignant or diverticular diseases, whether electively or on emergency basis, within a 4-month period were included in a prospective multicenter study conducted by the French Association for Surgery (Association Française de Chirurgie, AFC). The main outcome measure was postoperative in-hospital mortality. Independent factors leading to death were assessed by multivariate logistic regression analysis (AFC-index). The ratio of expected versus observed deaths was calculated, and the predictive value of the POSSUM and P-POSSUM scores were analyzed by the receiver operating characteristic (ROC) curve. A total of 1426 patients were included. The in-hospital death rate was 3.4%. Four independent preoperative factors (AFC-index) have been found: emergency surgery, loss of more than 10% of weight, neurological disease history, and age > 70 years. POSSUM had a poor predictive value; it overestimated postoperative death in all cases. P-POSSUM had a good predictive value, except for elective surgery, where it overestimated postoperative death twofold. The predictive value of the AFC-index was also good. It had the same sensitivity and specificity as the P-POSSUM. POSSUM has not been validated in France in the field of colorectal surgery. P-POSSUM was as predictive as the AFC-index which is a simpler instrument based on four clinical parameters (without any mathematical formulas). P redicting the risk of death after surgery is an important part of the surgical audit. Several riskscoring systems have been published 1 aiming to predict mortality or morbidity at an early stage of hospital stay. Of these scores or indexes, the POSSUM scoring system (Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) 2 remains the K.S.
Open Medicine
Background Colorectal cancer (CRC) is one of the most common cancers in patients older than 65 years. Emergency presentation represents about 30% of cases, with increased morbidity and mortality rates. The aim of this study is to compare the perioperative outcome between elderly and non-elderly patients undergoing emergency surgery. Method We retrospectively analysed CRC patients that underwent emergency surgery at the Departments of Surgery of the Sapienza University Sant’Andrea Hospital in Rome, and at San Donato Hospital in Arezzo, between June 2012 and June 2017. Patients were divided into two groups: non-elderly (< 65 years) and elderly (≥ 65 years). Variables analysed were sex, onset symptoms, associated disease, ASA score, tumor site and TNM stage, surgical procedures and approach, and morbidity and mortality. Results Of a total of 123 patients, 29 patients were non-elderly and 94 patients were elderly. No significant differences were observed in sex, onset symptoms and tu...
Bali Medical Journal
Background: Many scoring systems have been developed to predict outcomes after surgery, but it has limitations due to differences in population, comorbidity, type of surgery, or hospital effects. External validation from these scoring systems sometimes failed to achieve good discriminatory power consistently. This study aims to develop a novel scoring system for predicting postoperative mortality and comparing its performance with the AFC, CR-POSSUM, IRCS, and ACS-NSQIP SRC model.Methods: Data were collected retrospectively from all consecutive patients (n=1,294) undergoing colorectal cancer surgery in Dr. Soetomo Hospital between 2011 and 2020. After excluding missing data and 215 patients who did not satisfy the inclusion criteria, multivariate logistic regression analysis was performed in 1,079 patients to estimate odds ratios (ORs) and 95% confidence intervals (CIs) linking the explanatory variable postoperative mortality, and a Surabaya scoring system was constructed. Data were...
Multifactorial index of preoperative risk factors in colon resections
Diseases of The Colon & Rectum, 1992
Our aim was to analyze the predictive value of a variety of preoperative risk factors on operative outcomes. We reviewed all colorectal resections performed in a single hospital between January 1985 and May 1990. Nine hundred seventy-two resections were performed on 825 patients. We studied 17 preoperative risk factors generated from various medical risk categories. Using the multivariate discriminant function analysis, we calculated that 11 of the 17 risks were of significance in predicting outcomes (all with P ≤0.031). These factors included emergent operation, age ≥75 years, congestive heart failure (CHF), prior abdominal or pelvic radiation therapy, corticosteroid use, albumin <2.7 g/dl, chronic obstructive pulmonary disease (COPD), previous myocardial infarction (MI), diabetes, cirrhosis, and renal insufficiency. The classification function generated by the discriminant analysis was used to categorize patients into one of four risk groups depending on their “risk score.” The index used to develop each patient's “risk score” ranged from six points for an emergency operation to one point for diabetes. The mortality rates for the various risk groups were as follows: Group 1, zero to four points, 1 percent; Group 2, five to eight points, 10 percent; Group 3, 9 to 13 points, 19 percent; Group 4, >13 points, 33 percent. In contrast to previous reports, we showed that age ≥75 years alone is not a major preoperative risk factor but, rather, acts as a modifier for the other predictors of postoperative complications. We then assessed clinical questions concerning specific preoperative risks, such as steroid use, obesity, inflammatory bowel disease, COPD, and prior laparotomy, and their associated specific postoperative complications and have developed prevention strategies based on these findings. Through the use of the risk index, we also were able to assess an individual patient's operative risk more accurately.
Postoperative 30-Day Mortality After Colon Cancer Surgery: A Descriptive Case Series
2007
Objective: To analyze postoperative 30-day mortality (PostopM) after colon cancer (CC) surgery and to propose perioperative measures that can decrease complications and death. Patients and methods: Patients with CC who had undergone primary surgery at the Central Armed Forces Hospital (CAFH) in Montevideo, Uruguay, between 1989 and 2005 were identified. We included patients who died in the 30 days following surgery. Results: 282 patients underwent surgery for CC in the mentioned period. Fourteen patients died in the 30 days following surgery (4.9%). Eight patients (57.1 %) required urgent surgical management of bowel obstruction. The most common causes of death were anastomotic dehiscence and respiratory insufficiency/infections. PostopM occurred more frequently in emergency than in elective settings, especially in patients with left-sided tumors (p=0.01). Conclusions: To our knowledge this is the first study that analyzes PostopM exclusively in patients with CC. Attention must be paid to minimize operative risk, in some cases by the use of non-surgical approaches (stents). Routine use of a standardized regimen of prophylactic antibiotics, thromboprophylaxis +/-physiotherapy can decrease morbidity/mortality.
Perioperative Medicine, 2020
Background: Gastrointestinal cancer surgery continues to be a significant cause of postoperative complications and mortality in high-risk patients. It is crucial to identify these patients. Our study aimed to evaluate the accuracy of specific perioperative risk assessment tools to predict postoperative complications, identifying the most informative variables and combining them to test their prediction ability as a new score. Methods: A prospective cohort study of digestive cancer surgical patients admitted to the surgical intermediate care unit of the Portuguese Oncology Institute of Porto, Portugal was conducted during the period January 2016 to April 2018. Demographic and medical information including sex, age, date from hospital admission, diagnosis, emergency or elective admission, and type of surgery, were collected. We analyzed and compared a set of measurements of surgical risk using the risk assessment instruments P-POSSUM Scoring, ACS NSQIP Surgical Risk Calculator, and ARISCAT Risk Score according to the outcomes classified by the Clavien-Dindo score. According to each risk score system, we studied the expected and observed post-operative complications. We performed a multivariable regression model retaining only the significant variables of these tools (age, gender, physiological P-Possum, and ACS NSQIP serious complication rate) and created a new score (MyIPOrisk-score). The predictive ability of each continuous score and the final panel obtained was evaluated using ROC curves and estimating the area under the curve (AUC). Results: We studied 341 patients. Our results showed that the predictive accuracy and agreement of P-POSSUM Scoring, ACS NSQIP Surgical Risk Calculator, and ARISCAT Risk Score were limited. The MyIPOrisk-score, shows to have greater discrimination ability than the one obtained with the other risk tools when evaluated individually (AUC = 0.808; 95% CI: 0.755-0.862). The expected and observed complication rates were similar to the new risk tool as opposed to the other risk calculators.
The American Surgeon, 2022
ObjectivesImproved screening has decreased but not eliminated the need for emergent surgery for colon cancer (CC), many of which are performed by acute care surgery (ACS) surgeons. This retrospective review compares outcomes for CC resections on the ACS service to the surgical oncology and colorectal services (SO/CRS).MethodsRetrospective review was performed for CC operations between 2014 and 2019. Data for margin status, cancer stage, number of lymph nodes dissected, time to medical oncology follow-up, and time to initiation of chemotherapy were collected. Patients with curative resection, who chose comfort care, presented on alternative services or with non-CC indications as well as those were lost to follow-up were excluded.Results36 ACS patients and 269 SO/CRS patients underwent CC resections. Most ACS patients presented emergently compared to the SO/CC group (83.3% vs 1%, P < .05) as well as with more advanced tumor stage. There were no statistically significant differences...