Operative outcomes beyond 30-day mortality: colorectal cancer surgery in oldest old

Resections for elderly colorectal cancer (CRC) are forecasted to grow, particularly in those beyond the age limit of screening (>80 years). However, literature on operative outcomes after CRC procedures in the oldest old is focused primarily on operative mortality. We hypothesize that older age will additionally impact operative morbidity after CRC resections in a multihospital, risk-adjusted database.

We identified 19,375 patients >40 years who underwent CRC procedures in the 2005 to 2008 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Pre-, intra-, and postoperative factors were compared by age groups. Multivariable techniques were used to assess the effects of older age on operative outcome measures, adjusting for covariates.

Over 20% of our cohort was older than 80 years. Of those, 17% developed major complications and 29% experienced prolonged length of stay (LOS). Older patients also experienced higher rates of 30-day operative mortality (>80 years vs. 45-55 years; 6% vs. <1%), major complications (>80 years vs. 45-55 years; 21% vs. 14%), and prolonged LOS after open (>80 years vs. 45-55 years; 37% vs. 24%) and laparoscopic procedures (>80 years vs. 45-55 years; 40.5% vs. 18%). These unadjusted comparisons persisted in multivariable analyses demonstrating that older age independently predicted worse operative outcomes after CRC procedures.

The effects of older age extend to other important outcome measures after CRC procedures beyond operative mortality. As one of the largest multihospital studies, our study identified increased morbidity in the oldest old, a growing population. Our results should stimulate review of current policy and resource allocation.