Background: Urgent surgery for colorectal cancer (CRC) is associated with increased mortality and postoperative complications (POCs). Guidelines are based on low-grade evidence and small series. We aimed to define risk factors for mortality and severe (Clavien-Dindo>=III) POCs in patients undergoing urgent surgery for CRC. Methods: This is a retrospective, multicenter cohort study from 2018 to 2021 in 81 centers in Italy, including tertiary centers and community hospitals. We used data from the COVID-CRC Study Group database including palliative and curative surgery for colorectal cancer. Exclusion criteria were non-colorectal tumors and perioperative COVID-19 diagnosis. Risk factors were determined using logistic regression, multivariate models used p-value<=0.10 variables at univariate. Results: Urgent surgery rate for CRC was 11.4% (1897/16649) during the 4 years of the study and was associated with a higher rate of 30-day mortality (8.0% vs 1.4%) and severe POCs (15.8% vs 9.7%) than elective surgery. At multivariate, 30-day mortality for urgent surgery was associated with older age, cardiovascular (OR=1.73, 95%CI 1.04-2.88, p=0.035), pulmonary (OR=1.90, 95%CI 1.14-3.17, p=0.014), and neurological (OR=2.13, 95%CI 1.24-3.65, p=0.006) comorbidities, inflammatory bowel disease (OR=5.20, 95%CI 1.00-26.88, p=0.049), intraoperative complications (OR=4.05, 95%CI 2.03-8.09, p<0.0001), T4 disease (OR=2.11, 95%CI 1.31-3.40, p=0.002), and metastatic disease (OR=2.11, 95%CI 1.31-3.40, p=0.002). While, 30-day severe POCs were associated with male sex, cardiovascular (OR=1.40, 95%CI 1.03-1.90, p=0.030), and neurological comorbidities (OR=1.94, 95%CI 1.33-2.84, p=0.001), intraoperative complications (OR=3.92, 95%CI 2.45-6.26, p<0.0001). Female sex (OR=0.75, 95%CI 0.57-0.98, p=0.036) and laparoscopic approach (OR=0.67, 95%CI 0.49-0.93, p=0.015) were associated with a reduced risk of 30-day severe postoperative complications. Conclusions: We reported risk factors for 30-day mortality and severe postoperative complications for urgent CRC surgery using real-world data from a large cohort study in Italy.
Giacomo Calini, L.S. (2023). RISK FACTORS FOR MORTALITY AND SEVERE POSTOPERATIVE COMPLICATIONS AFTER URGENT SURGERY FOR COLORECTAL CANCER IN AN ITALIAN SERIES OF 16000 PATIENTS..
RISK FACTORS FOR MORTALITY AND SEVERE POSTOPERATIVE COMPLICATIONS AFTER URGENT SURGERY FOR COLORECTAL CANCER IN AN ITALIAN SERIES OF 16000 PATIENTS.
Giacomo Calini;Lorenzo Serafini;Gerti Dajti;Alice Gori;Gilberto Poggioli;Matteo Rottoli;
2023
Abstract
Background: Urgent surgery for colorectal cancer (CRC) is associated with increased mortality and postoperative complications (POCs). Guidelines are based on low-grade evidence and small series. We aimed to define risk factors for mortality and severe (Clavien-Dindo>=III) POCs in patients undergoing urgent surgery for CRC. Methods: This is a retrospective, multicenter cohort study from 2018 to 2021 in 81 centers in Italy, including tertiary centers and community hospitals. We used data from the COVID-CRC Study Group database including palliative and curative surgery for colorectal cancer. Exclusion criteria were non-colorectal tumors and perioperative COVID-19 diagnosis. Risk factors were determined using logistic regression, multivariate models used p-value<=0.10 variables at univariate. Results: Urgent surgery rate for CRC was 11.4% (1897/16649) during the 4 years of the study and was associated with a higher rate of 30-day mortality (8.0% vs 1.4%) and severe POCs (15.8% vs 9.7%) than elective surgery. At multivariate, 30-day mortality for urgent surgery was associated with older age, cardiovascular (OR=1.73, 95%CI 1.04-2.88, p=0.035), pulmonary (OR=1.90, 95%CI 1.14-3.17, p=0.014), and neurological (OR=2.13, 95%CI 1.24-3.65, p=0.006) comorbidities, inflammatory bowel disease (OR=5.20, 95%CI 1.00-26.88, p=0.049), intraoperative complications (OR=4.05, 95%CI 2.03-8.09, p<0.0001), T4 disease (OR=2.11, 95%CI 1.31-3.40, p=0.002), and metastatic disease (OR=2.11, 95%CI 1.31-3.40, p=0.002). While, 30-day severe POCs were associated with male sex, cardiovascular (OR=1.40, 95%CI 1.03-1.90, p=0.030), and neurological comorbidities (OR=1.94, 95%CI 1.33-2.84, p=0.001), intraoperative complications (OR=3.92, 95%CI 2.45-6.26, p<0.0001). Female sex (OR=0.75, 95%CI 0.57-0.98, p=0.036) and laparoscopic approach (OR=0.67, 95%CI 0.49-0.93, p=0.015) were associated with a reduced risk of 30-day severe postoperative complications. Conclusions: We reported risk factors for 30-day mortality and severe postoperative complications for urgent CRC surgery using real-world data from a large cohort study in Italy.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
