Cardiac risk stratification in emergency resection for colonic tumours

Area of Science:

• Oncology
• Cardiology
• Surgical Outcomes

Background:

• Postoperative mortality after emergency colorectal cancer resection remains high despite perioperative care advances.
• Risk stratification is crucial for optimizing patient care and cardiac risk assessment.
• The Revised Cardiac Risk Index (RCRI) is a practical tool for evaluating cardiac risk.

Purpose of the Study:

• To assess the utility of the RCRI in identifying patients who would benefit from perioperative cardiac risk mitigation after emergency oncological colonic resection.
• To test the hypothesis that RCRI can stratify cardiac risk in this patient population.

Main Methods:

• Retrospective analysis of 5703 patients undergoing emergency resection for colonic cancer (2007-2017) from the Swedish Colorectal Cancer Registry.
• Cross-referencing with national health data for mortality and comorbidity information.
• Calculation of RCRI scores and correlation with 90-day postoperative mortality using Poisson regression.

Main Results:

• A significant linear increase in 90-day postoperative mortality was observed with rising RCRI scores (37.3% for RCRI ≥4 vs. 11.3% for RCRI 1).
• Increased RCRI scores were associated with significantly higher adjusted 90-day all-cause mortality risk (IRR 2.07 for RCRI ≥4 vs. RCRI 1).

Conclusions:

• Increasing cardiac risk, as indicated by the RCRI, is associated with higher 90-day postoperative mortality in emergency colorectal surgery for cancer.
• Patients with elevated RCRI scores in this setting are high-risk and likely to benefit from enhanced postoperative monitoring and critical care.