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Emergency room presentation of colorectal cancer: a consecutive cohort study
Alex D Mitchell1, Karen M Inglis, John M Murdoch
1Division of General Surgery, Dalhousie University, Halifax, NS, Canada. admitche@dal.ca
Background:
Emergency room presentation (ERP) in colorectal cancer (CRC) is associated with worse cancer-related outcomes. The goal of this study was to determine the frequency of ERP and identify factors associated with ERP of CRC.
Methods:
We performed a prospective consecutive cohort study of all patients undergoing resection for CRC from 02/2002 to 02/2004. Standardized data collection involved hospital record review, patient interview, and prospective follow-up. ERP was defined as the diagnosis and/or surgical treatment of CRC as a result of presentation to the emergency department.
Results:
Of the 455 patients in the study 108 (24%) had ERP. Presentation of those with ERP was obstruction in 46 (43%), bleeding/anemia in 35 (32%), pain in 25 (23%), and other (2%). The ERP cohort was older (mean age 70.8 vs. 67.0 years, P = 0.005). ERP was more common amongst females (29.7 vs. 18.2%, P = 0.004) and obesity appears to be associated with increased rates of ERP. ERP of CRC was associated with more advanced TNM stage. The ERP cohort had longer length of stay in hospital (median 10 vs. 8 days respectively, P < 0.001). Peri-operative mortality was higher in ERP patients (7.4 vs. 2.3%, P = 0.03).
Conclusions:
ERP in CRC was not infrequent and appeared to be associated with female gender and weight. The known negative prognostic impact of ERP, combined with the increased peri-operative mortality and length of stay, would suggest a potential benefit to targeted strategies aimed at reducing the use of the emergency room in the diagnosis and treatment of CRC.
