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Predicting mortality within 90 days of first intervention in patients with left-sided obstructive colon cancer
BACKGROUND:
Acute resection for left-sided obstructive colon carcinoma is thought to be associated with a higher mortality risk than a bridge-to-surgery approach using decompressing stoma or self-expandable metal stent, but prediction models are lacking.
OBJECTIVE:
This study aimed to determine the influence of treatment strategy on mortality within 90 days from the first intervention in patients presenting with left-sided obstructive colon carcinoma.
DESIGN:
This was a national multicenter cohort study that used data from a prospective national audit.
SETTINGS:
The study was performed in 75 Dutch hospitals.
PATIENTS:
Patients were included if they underwent resection with curative intent for left-sided obstructive colon carcinoma between 2009 and 2016.
INTERVENTIONS:
First intervention was either acute resection, bridge to surgery with self-expandable metallic stent, or bridge to surgery with...
Show moreBACKGROUND:
Acute resection for left-sided obstructive colon carcinoma is thought to be associated with a higher mortality risk than a bridge-to-surgery approach using decompressing stoma or self-expandable metal stent, but prediction models are lacking.
OBJECTIVE:
This study aimed to determine the influence of treatment strategy on mortality within 90 days from the first intervention in patients presenting with left-sided obstructive colon carcinoma.
DESIGN:
This was a national multicenter cohort study that used data from a prospective national audit.
SETTINGS:
The study was performed in 75 Dutch hospitals.
PATIENTS:
Patients were included if they underwent resection with curative intent for left-sided obstructive colon carcinoma between 2009 and 2016.
INTERVENTIONS:
First intervention was either acute resection, bridge to surgery with self-expandable metallic stent, or bridge to surgery with decompressing stoma.
MAIN OUTCOME MEASURES:
The main outcome measure was 90-day mortality after the first intervention. Risk factors were identified using multivariable logistic analysis. Subsequently, a risk model was developed.
RESULTS:
In total, 2395 patients were included, with the first intervention consisting of acute resection in 1848 patients (77%), stoma as bridge to surgery in 332 patients (14%), and stent as bridge to surgery in 215 patients (9%). Overall, 152 patients (6.3%) died within 90 days from the first intervention. A decompressing stoma was independently associated with lower 90-day mortality risk (HR, 0.27; 95% CI, 0.094–0.62). Other independent predictors for mortality were age, ASA classification, tumor location, and index levels of serum creatinine and C-reactive protein. The constructed risk model had an area under the curve of 0.84 (95% CI, 0.81–0.87).
LIMITATIONS:
Only patients who underwent surgical resection were included.
CONCLUSIONS:
Treatment strategy had a significant impact on 90-day mortality. A decompressing stoma considerably lowers the risk of mortality, especially in older and frail patients. The developed risk model needs further external validation.
Show less- All authors
- Burghgraef, T.A.; Bakker, I.S.; Veld, J.V.; Wijsmuller, A.R.; Amelung, F.J.; Bemelman, W.A.; Borg, F. ter; Hooft, J.E. van; Siersema, P.D.; Tanis, P.J.; Consten, E.C.J.; Dutch Snapshot Res Grp
- Date
- 2023-10-01
- Journal
- Diseases of the Colon and Rectum
- Volume
- 66
- Issue
- 10
- Pages
- 1309 - 1318