Determinants of outcome after colorectal resection within an enhanced recovery programme

Author:

Hendry P O1,Hausel J2,Nygren J2,Lassen K3,Dejong C H C4,Ljungqvist O5,Fearon K C H1

Affiliation:

1. Edinburgh Royal Infirmary, Edinburgh, UK

2. Ersta Hospital, Stockholm, Sweden

3. University Hospital Northern Norway, and University of Tromsø, Tromsø, Norway

4. University Hospital Maastricht and NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands

5. Karolinska Institute, Stockholm, Sweden

Abstract

Abstract Background Postoperative outcomes were studied in relation to adverse nutritional risk (body mass index (BMI) below 20 kg/m2), advanced age (80 years or more) and co-morbidity (American Society of Anesthesiologists (ASA) grade III–IV) in patients undergoing colorectal resection within an enhanced recovery after surgery programme. Methods Outcomes were audited prospectively in 1035 patients. Morbidity and mortality were compared with those predicted using the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity, and a multivariable model was used to determine independent predictors of outcome. Results Postoperative morbidity was lower than predicted (observed to expected 0·68; P < 0·001). Independent predictors of delayed mobilization were ASA III–IV (P < 0·001) and advanced age (P = 0·025). Prolonged hospital stay was related to advanced age (P = 0·002), ASA III–IV (P < 0·001), male sex (P = 0·037) and rectal surgery (P < 0·001). Morbidity was related to ASA III–IV (P = 0·004), male sex (P = 0·023) and rectal surgery (P = 0·002). None of the factors predicted 30-day mortality. Conclusion Age and nutritional status were not independent determinants of morbidity or mortality. Pre-existing co-morbidity was an independent predictor of several outcomes.

Funder

Netherlands Organization for Health Research and Development

Swedish Research Council

Stockholm County Council and the Sodenbergs Foundation

Publisher

Oxford University Press (OUP)

Subject

Surgery

Reference41 articles.

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