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Infectious Postoperative Complications Decrease Long-term Survival in Patients Undergoing Curative Surgery for Colorectal Cancer: A Study of 12,075 Patients

Artinyan, Avo MD, MS*,†; Orcutt, Sonia T. MD; Anaya, Daniel A. MD*,†,‡; Richardson, Peter PhD‡,§; Chen, G. John MD, PhD, MPH‡,§; Berger, David H. MD, MHCM*,†,‡

doi: 10.1097/SLA.0000000000000854
Original Articles

Objective: We sought to characterize the effect of postoperative complications on long-term survival after colorectal cancer (CRC) resection.

Background: The impact of early morbidity on long-term survival after curative-intent CRC surgery remains controversial.

Methods: The Veterans Affairs Surgical Quality Improvement Program and Central Cancer Registry databases were linked to acquire perioperative and cancer-specific data for 12,075 patients undergoing resection for nonmetastatic CRC (1999–2009). Patients were categorized by presence of any complication within 30 days and by type of complication (noninfectious vs infectious). Univariate and multivariate survival analyses adjusted for patient, disease, and treatment factors were performed, excluding early deaths (<90 days). Subset analysis was performed to determine the specific impact of severe postoperative infections.

Results: The overall morbidity and infectious complication rates were 27.8% and 22.5%, respectively. Patients with noninfectious postoperative complications were older, had lower preoperative serum albumin, had worse functional status, and had higher American Society of Anesthesiologists scores than patients with infectious complications and without complications (all P < 0.001). The presence of any complication was independently associated with decreased long-term survival [hazard ratio, 1.24; 95% confidence interval (1.15–1.34)]. Multivariate analysis by complication type demonstrated increased risk only with infectious complications [hazard ratio, 1.31; 95% confidence interval (1.21–1.42)]. Subset analysis demonstrated this effect predominantly in patients with severe infections [hazard ratio, 1.41; 95% confidence interval (1.15–1.73)].

Conclusions: The presence of postoperative complications after CRC resection is associated with decreased long-term survival, independent of patient, disease, and treatment factors. The impact on long-term outcome is primarily driven by infectious complications, particularly severe postoperative infections.

The Veterans Affairs Surgical Quality Improvement Program and Central Cancer Registry nationwide databases were systematically linked. We have demonstrated that postoperative complications after colorectal cancer resection are associated with decreased long-term survival excluding early mortality, and that this effect is primarily driven by infectious complications, particularly severe postoperative infections.

*Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX

Department of Surgery, Division of General Surgery and Surgical Oncology, Baylor College of Medicine, Houston, TX

Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety (iQuest), Houston, TX; and

§Department of Medicine, Baylor College of Medicine, Houston, TX.

Reprints: Avo Artinyan, MD, MS, Baylor College of Medicine, Department of Surgery, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, OCL 112, Houston, TX 77030. E-mail: artinyan@bcm.edu.

Disclosure: The opinions expressed are those of the authors and not necessarily those of the Department of Veterans Affairs or the United States Government. The authors have no relevant financial disclosures or conflicts of interest.

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