Study Shows Decreasing Numbers of Colorectal Cancer Resections and Improved In-Hospital Mortality in Older Patients
Nationwide data on mortality and morbidity from colorectal cancer resections in the aging population are lacking. In a study reported in JAMA Surgery, Jafari et al found that there has been an overall decrease in numbers of resections and improved in-hospital mortality in older patients, although risk-adjusted mortality and morbidity continue to be markedly higher than in younger patients.
Study Details
The study involved analysis of data on operative outcomes in 1,043,108 patients with colorectal cancer in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from January 2001 through December 2010. Postoperative complications and yearly trends were analyzed in patients stratified in age groups of 45 to 64, 65 to 69, 70 to 74, 75 to 79, 80 to 84, and ≥ 85 years.
Multivariate logistic regression was used to compare in-hospital mortality and morbidity between age groups ≥ 65 years and the 45 to 64 year group controlling for sex, comorbidities, procedure type, diagnosis, and hospital status. The primary outcome measures were in-hospital mortality and morbidity.
Operation Rates
Among all patients, 63.8% of operations were performed in those aged ≥ 65 years and 22.6% in those aged ≥ 80 years. The number of resections decreased by a mean of 5.1% per year in the entire population and 7.0% per year in those aged ≥ 65 years over the 10-year period, with the largest decrease (7.5%) in those aged 70 to 79 years.
Patients aged ≥ 85 years had a 1.7-fold higher rate of urgent admission (50.4%) compared with younger patients—29% in those aged 45 to 64 years, 29.6% in those aged 65 to 69, 31% in those aged 70 to 74, 34% in those aged 75 to 79, and 39% in those aged 80 to 84. Patients aged < 65 years accounted for 46.0% of elective laparoscopies, compared with 14.1% in those aged ≥ 80 years.
Mortality and Morbidity
Overall, the in-hospital mortality rate was 3.0%, with the lowest in those aged 45 to 64 years (1.3%) and the highest in those aged ≥ 85 years (8.0%); rates were 2.0% in the 65 to 69 year group, 2.9% in the 70 to 74 year group, 3.7% in the 75 to 79 year group, and 4.9% in the 80 to 84 year group. Mortality rates decreased by 6.6% per year over 10 years, with decreases of 9.1% in the ≥ 85 year group, 6.4% in the 80 to 84 year group, 7.5% in the 75 to 79 year group, 7.7% in the 65 to 69 year group, and 1.7% in the 45 to 64 year group.
On multivariate risk-adjusted analysis, compared with patients aged 45 to 64 years, risk of in-hospital mortality was significantly greater in those aged 65 to 69 years (odds ratio [OR] = 1.32, 95% confidence interval [CI] =1.18–1.49), 70 to 74 years (OR = 2.02, 95% CI =1.82–2.24), 75 to 79 years (OR = 2.51, 95% CI = 2.28–2.76), 80 to 84 years (OR = 3.15, 95% CI = 2.86–3.46), and ≥ 85 years (OR = 4.72, 95% CI = 4.30–5.18) (P < .01 for trend).
In-hospital morbidity rates were 27.4% in the 45 to 64 year group, 32.2% in the 65 to 69 year group, 34.9% in the 70 to 74 year group, 37.2% in the 75 to 79 year group, 40.0% in the 80 to 84 year group, and 44.9% in the ≥ 85 year group. Compared with patients aged 45 to 64 years, risk of morbidity was significantly greater in those aged 65 to 69 years (OR = 1.25; 95% CI = 1.21–1.29), 70 to 74 years (OR = 1.40, 95% CI = 1.36–1.45), 75 to 79 years (OR = 1.54, 95% CI = 1.49–1.58), 80 to 84 years (OR = 1.68, 95% CI = 1.63–1.74), and ≥ 85 years (OR = 1.96, 95% CI = 1.89–2.03) (P < .01 for trend).
Patients in the ≥ 85 years group had higher in-hospital charges ($58,863) and longer hospital length of stay (12 days) compared with the 45 to 64 year group ($47,395, 9 days). For patients aged ≥ 80 years, cost was increased by $9,492 and stay by 2.5 years compared with the < 65 year group.
The investigators concluded, “Most operations for colorectal cancer are performed on the aging population, with an overall decrease in the number of cases performed. Despite the overall improved mortality seen during the past 10 years, the risk-adjusted mortality and morbidity of the elderly continue to be substantially higher than that for the younger population.”
Michael J. Stamos, MD, of University of California, Irvine, is the corresponding author for the JAMA Surgery article.
The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
