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Preoperative functional health status may predict outcomes after elective colorectal surgery for malignancy

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Abstract

Background

Several studies suggest that preoperative functional health status (FHS) affects postoperative outcomes after ventral hernia repair, hepatic resections, and infrainguinal by-pass surgery. However, little is known about the proficiency of FHS in terms of preoperative outcome prediction of patients who undergo elective resection for colorectal cancer.

Methods

All patients who underwent elective colorectal resections for malignancy between 2005 and 2009 were identified from the American College of Surgeons National Surgical Quality Improvement Program. We classified patients into three groups according to their preoperative FHS: independent (IND), partially dependent (PDN), and totally dependent (TDN). Multivariable techniques were used to evaluate the impact of FHS on postoperative outcomes. Outcomes of laparoscopic and open procedures in patients with dependent FHS were also compared.

Results

In total, 25,591 patients included (94.2 % IND, 5.1 % PDN, and 0.71 % TDN). Surgical, infectious, pulmonary, cardiovascular, renal, neurological complications, and mortality rate showed a linear progression that paralleled a decline in preoperative FHS of the patients (p < 0.05). Laparoscopic technique was associated with better outcomes in terms of reduced length of total hospital stay, decreased infectious complication rate, and mortality with comparable operating time in patients with dependent (PDN and TDN) FHS (p < 0.05).

Conclusions

Functional health status may predict postoperative outcomes after colorectal cancer surgery. A detailed preoperative evaluation, providing an optimization period before surgery if necessary, and increased utilization of laparoscopic technique may improve outcomes after elective colorectal resections for malignancy in patients who are partially or TDN.

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Acknowledgments

We would like to thank Amy Moore for her contribution in redaction process of the manuscript. American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Disclosures

Drs. Isik, Okkabaz, Remzi, and Gorgun and Mr. Hammel have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Ozgen Isik, Nuri Okkabaz, Jeffrey Hammel, Feza H. Remzi & Emre Gorgun

Authors
  1. Ozgen Isik
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  2. Nuri Okkabaz
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  3. Jeffrey Hammel
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  4. Feza H. Remzi
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  5. Emre Gorgun
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Corresponding author

Correspondence to Emre Gorgun.

Appendix

Appendix

See Table 4.

Table 4 CPT codes for included colorectal procedures
Full size table

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Isik, O., Okkabaz, N., Hammel, J. et al. Preoperative functional health status may predict outcomes after elective colorectal surgery for malignancy. Surg Endosc 29, 1051–1056 (2015). https://doi.org/10.1007/s00464-014-3777-2

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  • DOI: https://doi.org/10.1007/s00464-014-3777-2

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