Older Patients Fare Less Well After Colorectal Cancer Surgery

By David Douglas

April 15, 2014

NEW YORK (Reuters Health) - Although there's been a reduction in US colorectal cancer operations as well as improved outcome in recent years, the elderly still don't do as well as younger patients, according to California-based researchers.

As Dr. Michael J. Stamos told Reuters Health by email, "Although we were pleased to observe an overall decrease in the number of cases performed as well as a steady decrease in mortality, the risk adjusted mortality and morbidity of the elderly group remains substantially higher than the younger cohort."

In an April 9th online paper in JAMA Surgery, Dr. Stamos and colleagues at the University of California, Irvine note that an estimated 50% of all cancers and 70% of all cancer deaths occur in the elderly.

"With the 'graying' of the US population," continued Dr. Stamos, "more elderly patients can be expected to seek care, including for colorectal cancer. We therefore aimed to examine the trends and outcomes of colorectal cancer resection in the elderly by comparing patients over 65 years with patients between 45 and 64 years old."

The investigators used the Nationwide Inpatient Sample for the years 2001 to 2010. Over half (63.3%) of the more than 1 million patients estimated to have had colorectal cancer resection were more than 64 years old and 22.6% were 80 years old or older.

Elective laparoscopies were much more frequent in patients under 65 compared to those age 80 and above (46.0% vs 14.1%).

Patients age 80 and older were also 1.7 times more likely to undergo urgent admission than those younger than 65 years. Moreover, the older patients were more likely to stay at least 2.5 days and have hospital charges that were almost $9500 higher.

Over the study period, mortality decreased by a mean of 6.6%, with the most considerable decrease observed in the population 85 years old and older (9.1%).

Nevertheless, there was higher risk-adjusted in-hospital mortality with advancing age. The odds ratio ranged from 1.32 in patients aged 65 to 69 to 4.72 in those age 85 and older. Corresponding ratios for risk-adjusted morbidity were 1.25 and 1.96.

The researchers conclude that the data will help surgeons counsel patients and will "also reveal a demand for a reevaluation of current care patterns, reinforcing the need for future studies to account for the changing population landscape."

SOURCE: https://bit.ly/1m3nSNv

JAMA Surg 2014.

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