75岁老人停止结肠镜检查后异时性结直肠肿瘤需要手术的影响。

IF 1.6 4区 医学 Q3 SURGERY
Ammar Manasawala, John Woodfield, Kari Clifford, Mark Thompson Fawcett
{"title":"75岁老人停止结肠镜检查后异时性结直肠肿瘤需要手术的影响。","authors":"Ammar Manasawala, John Woodfield, Kari Clifford, Mark Thompson Fawcett","doi":"10.1111/ans.70199","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>To assess the clinical and financial impact of metachronous colorectal neoplasia (MCRN) requiring surgery after cessation of colonoscopic surveillance at age 75.</p><p><strong>Methods: </strong>The Otago Clinical Audit database was interrogated to identify all colorectal neoplasia (CRN) resections between January 2020 and November 2022 and additional patients undergoing surgery for MCRN aged ≥ 75 (MCRN ≥ 75) between 2010 and 2020. The morbidity, hospital stay, and costs of surgery for MCRN ≥ 75 cases were compared to first colorectal neoplasia (FCRN) cases ≥ 75 and to all other colorectal resections, with and without propensity matching.</p><p><strong>Results: </strong>MCRN was identified in 3.1% of patients < 75 and 13.1% of patients ≥ 75. Identifying a further 41 patients with surgery for MCRN ≥ 75 after 2010 resulted in 55 patients with MCRN aged ≥ 75, 93 with FCRN aged ≥ 75, and 130 with CRN aged < 75. The median(IQR) age for MCRN ≥ 75 was 81 (78-86). Surgery for MCRN ≥ 75 compared to FCRN ≥ 75 resulted in complication rates of 70.9% and 50.5% (p = 0.024), hospital stay nine versus seven days (p = 0.012), readmissions 20% versus 6.5% (p = 0.026) and cost of NZD 31 021 versus 24 157 (p = 0.028). When compared to all other resections, and adjusting for different approaches to rectal cancer in elderly patients, these differences all increased. The estimated annual hospital cost for MCRN ≥ 75 surgery was NZD 317 777.</p><p><strong>Conclusion: </strong>MCRN accounted for 13.1% of operations in patients aged ≥ 75. This resulted in more morbidity and cost than surgery for FCRN ≥ 75. Stopping surveillance of those with previous surgery for CRN at 75 years of age results in significant institutional cost and patient morbidity.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Impact of Metachronous Colorectal Neoplasia Requiring Surgery After Cessation of Colonoscopic Surveillance at Age 75.\",\"authors\":\"Ammar Manasawala, John Woodfield, Kari Clifford, Mark Thompson Fawcett\",\"doi\":\"10.1111/ans.70199\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>To assess the clinical and financial impact of metachronous colorectal neoplasia (MCRN) requiring surgery after cessation of colonoscopic surveillance at age 75.</p><p><strong>Methods: </strong>The Otago Clinical Audit database was interrogated to identify all colorectal neoplasia (CRN) resections between January 2020 and November 2022 and additional patients undergoing surgery for MCRN aged ≥ 75 (MCRN ≥ 75) between 2010 and 2020. The morbidity, hospital stay, and costs of surgery for MCRN ≥ 75 cases were compared to first colorectal neoplasia (FCRN) cases ≥ 75 and to all other colorectal resections, with and without propensity matching.</p><p><strong>Results: </strong>MCRN was identified in 3.1% of patients < 75 and 13.1% of patients ≥ 75. Identifying a further 41 patients with surgery for MCRN ≥ 75 after 2010 resulted in 55 patients with MCRN aged ≥ 75, 93 with FCRN aged ≥ 75, and 130 with CRN aged < 75. The median(IQR) age for MCRN ≥ 75 was 81 (78-86). Surgery for MCRN ≥ 75 compared to FCRN ≥ 75 resulted in complication rates of 70.9% and 50.5% (p = 0.024), hospital stay nine versus seven days (p = 0.012), readmissions 20% versus 6.5% (p = 0.026) and cost of NZD 31 021 versus 24 157 (p = 0.028). When compared to all other resections, and adjusting for different approaches to rectal cancer in elderly patients, these differences all increased. The estimated annual hospital cost for MCRN ≥ 75 surgery was NZD 317 777.</p><p><strong>Conclusion: </strong>MCRN accounted for 13.1% of operations in patients aged ≥ 75. This resulted in more morbidity and cost than surgery for FCRN ≥ 75. Stopping surveillance of those with previous surgery for CRN at 75 years of age results in significant institutional cost and patient morbidity.</p>\",\"PeriodicalId\":8158,\"journal\":{\"name\":\"ANZ Journal of Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-05-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ANZ Journal of Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/ans.70199\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ANZ Journal of Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/ans.70199","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0

摘要

背景:评估75岁停止结肠镜检查后需要手术的异时性结直肠肿瘤(MCRN)的临床和经济影响。方法:对奥塔哥临床审计数据库进行查询,以确定2020年1月至2022年11月期间所有结肠直肠癌瘤变(CRN)切除术,以及2010年至2020年期间年龄≥75岁(MCRN≥75)接受MCRN手术的其他患者。将MCRN≥75例的发病率、住院时间和手术费用与首次结直肠肿瘤(FCRN)≥75例和所有其他结直肠切除术进行比较,有无倾向匹配。结论:在年龄≥75岁的患者中,MCRN占手术的13.1%。这导致FCRN≥75患者的发病率和费用高于手术。在75岁时停止对既往CRN手术患者的监测,会导致显著的机构成本和患者发病率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Impact of Metachronous Colorectal Neoplasia Requiring Surgery After Cessation of Colonoscopic Surveillance at Age 75.

Background: To assess the clinical and financial impact of metachronous colorectal neoplasia (MCRN) requiring surgery after cessation of colonoscopic surveillance at age 75.

Methods: The Otago Clinical Audit database was interrogated to identify all colorectal neoplasia (CRN) resections between January 2020 and November 2022 and additional patients undergoing surgery for MCRN aged ≥ 75 (MCRN ≥ 75) between 2010 and 2020. The morbidity, hospital stay, and costs of surgery for MCRN ≥ 75 cases were compared to first colorectal neoplasia (FCRN) cases ≥ 75 and to all other colorectal resections, with and without propensity matching.

Results: MCRN was identified in 3.1% of patients < 75 and 13.1% of patients ≥ 75. Identifying a further 41 patients with surgery for MCRN ≥ 75 after 2010 resulted in 55 patients with MCRN aged ≥ 75, 93 with FCRN aged ≥ 75, and 130 with CRN aged < 75. The median(IQR) age for MCRN ≥ 75 was 81 (78-86). Surgery for MCRN ≥ 75 compared to FCRN ≥ 75 resulted in complication rates of 70.9% and 50.5% (p = 0.024), hospital stay nine versus seven days (p = 0.012), readmissions 20% versus 6.5% (p = 0.026) and cost of NZD 31 021 versus 24 157 (p = 0.028). When compared to all other resections, and adjusting for different approaches to rectal cancer in elderly patients, these differences all increased. The estimated annual hospital cost for MCRN ≥ 75 surgery was NZD 317 777.

Conclusion: MCRN accounted for 13.1% of operations in patients aged ≥ 75. This resulted in more morbidity and cost than surgery for FCRN ≥ 75. Stopping surveillance of those with previous surgery for CRN at 75 years of age results in significant institutional cost and patient morbidity.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
ANZ Journal of Surgery
ANZ Journal of Surgery 医学-外科
CiteScore
2.50
自引率
11.80%
发文量
720
审稿时长
2 months
期刊介绍: ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信