Reoperation After Colorectal Surgery Is an Independent Predictor of the 1-Year Mortality Rate

• Published in: Diseases of the colon & rectum Vol. 54; no. 11; pp. 1438 - 1442
• Main Authors: van Westreenen, Henderik L, IJpma, Frank F, Wevers, Kevin P, Afzali, Hamid, Patijn, Gijsbert A
• Format: Journal Article
• Language: English
• Published: Hagerstown, MDc The ASCRS 01.11.2011; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Colectomy - mortality; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Elective Surgical Procedures - mortality; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Neoplasm Staging; Predictive Value of Tests; Reoperation - mortality; Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Rate; Reoperation; Prognosis; Mortality; Quality control; Gastroenterology; 1-year mortality; Quality assessment; Predictive factor; Epidemiology; Colorectal surgery
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1097/DCR.0b013e31822c64f1

BACKGROUND:Comparative evaluation of surgical quality among hospitals must improve outcome and efficiency, and reduce medical costs. Reoperation after colorectal surgery is a consequence of surgical complications and therefore considered a quality-of-care indicator. With respect to the mortality rate, the 1-year mortality may be a more meaningful figure than in-hospital mortality, because it also reflects the impact of surgical complications beyond discharge. OBJECTIVE:The aim of our study was to evaluate the 1-year mortality after colorectal surgery and to identify predicting factors. DESIGN:This study was a retrospective analysis from our colorectal surgery database. PATIENTS:All patients who underwent elective colorectal surgery from 2005 to 2008 were included. MAIN OUTCOME MEASURES:Both univariate and multivariate analysis were performed to identify predicting factors. The following variables were analyzedage, operative risk according to the ASA class, Charlson-Age Comorbidity Index, indication for and type of resection, primary anastomosis, tumor staging, anastomotic leakage, and reoperation. RESULTS:For 743 consecutive patients, the 1-year mortality rate was 6.9%. Patients were operated on mainly because of colorectal cancer (n = 537; 72%). The rate of reoperation and in-hospital mortality was 12.8% and 2.4%. Univariate survival analysis demonstrated that ASA class, age, Charlson-Age Comorbidity Index, reoperation, and stage of disease were independent predictors of 1-year mortality. Multivariate analysis showed that ASA class (P = .020; HR 1.69), age (P = .015; HR 2.08) and reoperation (P = .001; HR 2.72) are directly correlated with 1-year mortality. LIMITATIONS:Both patients with benign diseases and colorectal cancer are included. Furthermore, no clear guidelines on whether to perform a reoperation were available. CONCLUSION:One-year mortality after colorectal surgery is independently predicted by ASA class, age, and reoperation. Our results underline the value of the 1-year mortality rate and the reoperation rate as parameters for quality assessment in colorectal surgery.