Background
Little is known about the postoperative status and support needs of patients undergoing
colorectal cancer operations. The objective of this study was to describe the disposition
and resource use of Ontario’s elderly population undergoing colorectal cancer operations
as well as to identify predictors of outcomes using population-based data.
Methods
A total of 33,238 patients aged 50 years and older with a diagnosis of colorectal
cancer were identified using International Classification of Diseases 9 and 10 codes
in the Ontario Cancer Registry linked to procedure codes in the Canadian Institute
for Health Information Discharge Abstract Database representing colorectal operations
within 6 months of diagnosis from 1997 to 2004. Data on an individual’s home-care
use were collected from the Ontario Home Care Administrative System. The cohort was
divided into the following age groups: 50–64 years, 65–74 years, 75–79 years, and
80 years and older. The primary outcomes assessed were postoperative mortality, length
of stay, discharge disposition, need for home care, and readmission within 30 days.
Results
Based on univariate and multivariate analyses, patients aged 75–79 years and 80 years
and older were more likely to die in hospital (odds ratio 2.84; 95% confidence interval
2.32–3.47 and odds ratio 5.72; 95% confidence interval 4.76–6.88), stay longer in
hospital (2.78 [standard error 0.22] and 5.16 [standard error 0.19] days, respectively),
not return home (odds ratio 5.62; confidence interval 3.99–7.98 and odds ratio 11.59;
confidence interval 8.32–16.13), receive home care (odds ratio 1.44; 95% confidence
interval 1.34–1.55 and odds ratio 1.71; 95% confidence interval 1.59–1.83), and be
readmitted (odds ratio 1.31; 95% confidence interval 1.19–1.45 and odds ratio 1.59;
95% confidence interval 1.44–1.75) compared with younger individuals. The rate of
discharge home for patients aged 80 years and older was more than 78%. Factors predisposing
patients older than 75 years to poorer outcomes were higher Charlson comorbidity score,
urgent admission, construction of a stoma, and reoperation.
Conclusion
Although discharge-related outcomes worsen with age, most elderly patients do well
and can return home after a colorectal cancer operation. Elderly patients require
more support; therefore, discharge planning should be part of preoperative assessment
and discussions.
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Article info
Publication history
Published online: March 14, 2011
Accepted:
December 24,
2010
Footnotes
Supported by the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care.
Identification
Copyright
© 2011 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
