Impact of postoperative complications on readmission and long-term survival in patients following surgery for colorectal cancer

• Published in: International journal of colorectal disease Vol. 32; no. 6; pp. 805 - 811
• Main Authors: Slankamenac, Ksenija, Slankamenac, Maja, Schlegel, Andrea, Nocito, Antonio, Rickenbacher, Andreas, Clavien, Pierre-Alain, Turina, Matthias
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2017; Springer; Springer Nature B.V
• Subjects: Aged; Analysis; Cancer patients; Classification; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - surgery; Complications; Complications and side effects; Disease-Free Survival; Female; Gastroenterology; Hepatology; Humans; Internal Medicine; Intraoperative Care; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Morbidity; Original Article; Patient outcomes; Patient Readmission; Postoperative Complications - etiology; Proctology; Stroke; Stroke (Disease); Surgery; Survival; Treatment Outcome; Outcome research; Comprehensive complication index; Complication; Readmission; Overall survival; Colorectal surgery; Morbidity
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-017-2811-y

Purpose
It is well known that specific postoperative complications such as stroke influence readmissions and overall survival (OS) after surgery for colorectal cancer (CRC). Whether overall hospital morbidity is associated with increased risk of readmission and poorer long-term survival is unknown. New tools are available to accurately quantify overall morbidity, such as the comprehensive complication index (CCI). The aim is to evaluate the impact of complications on readmission and overall survival (OS) in patients operated for colorectal cancer.
Methods
Postoperative complications of patients undergoing surgery for CRC were assessed over a 5-year period using the Clavien-Dindo classification, and overall morbidity was assessed by using the CCI. Individual scores were analyzed regarding their association with readmission and OS by using the multivariate logistic and Cox proportional-hazards regression analysis, respectively.
Results
Two hundred eighty-four patients were operated for CRC, of which 22 (8%) were readmitted. One hundred five patients (37%) developed at least one postoperative complication during the hospital stay. While single complications or the use of severe complication only (grade ≥IIIb) was not associated with readmission, overall morbidity (CCI) predicted readmission (OR 1.02 (95% CI 1.0–1.04),
p
 = 0.044). Similarly, morbidity assessed by the CCI had a significant negative predictive value on OS, e.g., patients with a CCI of 20 were 22% more likely to die within a 5-year follow-up, when compared to patients with a CCI of 10 (
p
 = 0.022).
Conclusions
Overall combined morbidity as assessed by the CCI leads to more frequent readmission, and is associated with poorer long-term survival after surgery for CRC.