COPD is a clear risk factor for increased use of resources and adverse outcomes in patients undergoing intervention for colorectal cancer: a nationwide study in Spain

Abstract

Marisa Baré,1,2 Concepción Montón,2,3 Laura Mora,2,4 Maximino Redondo,2,5 Marina Pont,1,2 Antonio Escobar,2,6 Cristina Sarasqueta,2,7,8 Nerea Fernández de Larrea,9,10 Eduardo Briones,10,11 Jose Maria Quintana2,12 1Clinical Epidemiology and Cancer Screening, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Sabadell, 2Research Network on Health Services in Chronic Diseases – REDISSEC, 3Service of Respiratory Medicine, 4Service of General Surgery, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Sabadell, 5Laboratory Service, Hospital Costa del Sol, Málaga, 6Unidad de Investigación, Hospital Universitario Basurto, Bilbao, 7Unidad de Investigación, Hospital Universitario Donostia, 8Instituto de Investigación Sanitaria Biodonostia, Donostia, 9Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 10CIBER Epidemiología y Salud Pública – CIBERESP, Madrid, 11Unidad de Epidemiología, Distrito Sevilla, Servicio Andaluz de Salud, Seville, 12Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao-Bizkaia, Spain Background: We hypothesized that patients undergoing surgery for colorectal cancer (CRC) with COPD as a comorbidity would consume more resources and have worse in-hospital outcomes than similar patients without COPD. Therefore, we compared different aspects of the care process and short-term outcomes in patients undergoing surgery for CRC, with and without COPD. Methods: This was a prospective study and it included patients from 22 hospitals located in Spain – 472 patients with COPD and 2,276 patients without COPD undergoing surgery for CRC. Clinical variables, postintervention intensive care unit (ICU) admission, use of invasive mechanical ventilation, and postintervention antibiotic treatment or blood transfusion were compared between the two groups. The reintervention rate, presence and type of complications, length of stay, and in-hospital mortality were also estimated. Hazard ratio (HR) for hospital mortality was estimated by Cox regression models. Results: COPD was associated with higher rates of in-hospital complications, ICU admission, antibiotic treatment, reinterventions, and mortality. Moreover, after adjusting for other factors, COPD remained clearly associated with higher and earlier in-hospital mortality. Conclusion: To reduce in-hospital morbidity and mortality in patients undergoing surgery for CRC and with COPD as a comorbidity, several aspects of perioperative management should be optimized and attention should be given to the usual comorbidities in these patients. Keywords: COPD, colorectal cancer, in-hospital mortality, reintervention, complications

Keywords

• COPD
• colorectal cancer
• mortality
• reintervention
• complications