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.
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, COVID–Colorectal Cancer (CRC) Study Group.. - ELETTRONICO. - (2023), pp. 1-1. (Intervento presentato al convegno SICCR 2023 tenutosi a Bari, ITA nel 02/10/2023).
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.
