Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia.
The Common Good Foundation, The Prince Charles Hospital, Brisbane, Queensland, Australia.
PLoS One. 2020 Dec 23;15(12):e0243995. doi: 10.1371/journal.pone.0243995. eCollection 2020.
Colorectal cancer surgery is complex and can result in severe post-operative complications. Optimisation of surgical outcomes requires a thorough understanding of the background complexity and comorbid status of patients.
The aim of this study is to determine whether certain pre-existing comorbidities are associated with high grade post-operative complications following colorectal cancer surgery. The study also aims to define the prevalence of demographic, comorbid and surgical features in a population undergoing colorectal cancer resection.
A colorectal cancer database at The Prince Charles Hospital was established to capture detailed information on patient background, comorbidities and clinicopathological features. A single-centre retrospective study was undertaken to assess the effect of comorbidities on post-operative outcomes following colorectal cancer resection. Five hundred and thirty-three patients were reviewed between 2010-2018 to assess if specific comorbidities were associated with higher grade post-operative complications. A Clavien-Dindo grade of three or higher was defined as a high grade complication.
Fifty-eight percent of all patients had an ASA grade of ASA III or above. The average BMI of patients undergoing resection was 28 ± 6.0. Sixteen percent of all patients experienced a high grade complications. Patients with high grade complications had a higher mean average age compared to patients with low grade or no post-operative complications (74 years vs 70 years, p = 0.01). Univariate analysis revealed patients with atrial fibrillation, COPD, ischaemic heart disease and heart failure had an increased risk of high grade complications. Multivariate analysis revealed pre-existing atrial fibrillation (OR 2.70, 95% CI 1.53-4.89, p <0.01) and COPD (OR 2.02 1.07-3.80, p = 0.029) were independently associated with an increased risk of high grade complications.
Pre-existing atrial fibrillation and COPD are independent risk factors for high grade complications. Targeted perioperative management is necessary to optimise outcomes.
结直肠癌手术复杂，术后可能发生严重并发症。优化手术结果需要充分了解患者的背景复杂性和合并症状态。
本研究旨在确定某些预先存在的合并症是否与结直肠癌手术后的高级别术后并发症相关。该研究还旨在确定接受结直肠癌切除术的人群中的人口统计学、合并症和手术特征的患病率。
在查尔斯王子医院建立了结直肠癌数据库，以获取有关患者背景、合并症和临床病理特征的详细信息。进行了一项单中心回顾性研究，以评估合并症对结直肠癌切除术后术后结果的影响。评估了 2010 年至 2018 年间的 533 例患者，以确定特定合并症是否与更高等级的术后并发症相关。Clavien-Dindo 分级为 3 级或更高定义为高级别并发症。
所有患者中有 58%的患者 ASA 分级为 ASA III 或更高。接受切除术的患者平均 BMI 为 28 ± 6.0。所有患者中有 16%经历了高级别并发症。与低级别或无术后并发症的患者相比，患有高级别并发症的患者的平均年龄更高（74 岁 vs 70 岁，p = 0.01）。单因素分析显示，患有心房颤动、COPD、缺血性心脏病和心力衰竭的患者发生高级别并发症的风险增加。多因素分析显示，预先存在的心房颤动（OR 2.70，95%CI 1.53-4.89，p <0.01）和 COPD（OR 2.02，1.07-3.80，p = 0.029）与高级别并发症的风险增加独立相关。
预先存在的心房颤动和 COPD 是高级别并发症的独立危险因素。需要有针对性的围手术期管理以优化结果。
