Surgical Procedures as Predictors of Postoperative Outcomes in Elderly Patients Undergoing Non-Emergency Colorectal Cancer Surgery.

Aim: Elderly patients are at increased risk of morbidity and prolonged hospital stays following non-emergency colorectal cancer (CRC) surgery. This study aimed to determine which surgical procedures are associated with postoperative morbidity and shorter postoperative hospital stay in elderly patients undergoing colorectal surgery.

Methods: Patients aged ≥75 years who underwent CRC resection between June 2015 and May 2019 at one hospital were included in this observational study. Logistic regression models were used to analyze the relationship between different surgical procedures and both overall postoperative complications and surgery-related complications, expressed as odds ratios (ORs) with 95% confidence intervals (CIs). The relationship between surgical procedures and postoperative hospital stay was evaluated using negative binomial regression, reported as incidence rate ratios (IRRs) with 95% CI. Additionally, Cox regression models were applied to assess the association between surgical procedures and postoperative mortality, expressed as hazard ratios (HRs) with 95% CIs.

Results: A total of 442 patients who underwent CRC resection were included, of whom 196 (44.34%) experienced postoperative complications and 121 (27.38%) had surgery-related complications. Patients undergoing anastomosis (adjusted OR = 0.43, 95% CI: 0.22-0.84, p = 0.014) had a lower risk of postoperative complications. Laparoscopy (adjusted OR = 0.51, 95% CI: 0.28-0.89, p = 0.019) was associated with a reduced risk of surgery-related complications. For postoperative hospital stay, laparoscopy (IRR = 0.883, 95% CI: 0.790-0.987, p = 0.027) was associated with shorter stays, whereas stoma formation (IRR = 1.154, 95% CI: 1.006-1.326, p = 0.044) was associated with prolonged hospital stay. Moreover, stoma formation (HR = 5.18, 95% CI: 1.03-25.91, p = 0.045) was associated with an increased risk of postoperative mortality.

Conclusions: Anastomosis and laparoscopy were associated with a lower risk of complications, while stoma formation was related to poorer prognosis in elderly patients undergoing CRC resection. The influence of surgical procedure choice on postoperative outcomes should be carefully considered.