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Association of Comorbidity with Anastomotic Leak, 30-day Mortality, and Length of Stay in Elective Surgery for Colonic Cancer: A Nationwide Cohort Study

Krarup, Peter-Martin M.D1,2; Nordholm-Carstensen, Andreas M.D.1; Jorgensen, Lars Nannestad M.D., D.M.Sc.1; Harling, Henrik M.D., D.M.Sc.1

Diseases of the Colon & Rectum: July 2015 - Volume 58 - Issue 7 - p 668–676
doi: 10.1097/DCR.0000000000000392
Original Contributions

BACKGROUND: Comorbidity has a negative influence on the long-term prognosis in patients with colorectal cancer, whereas its impact on the postoperative course is less clear.

OBJECTIVES: The aim of this study was to investigate the influence of comorbidity on anastomotic leak and short-term outcomes after resection for colonic cancer.

DESIGN: This is a retrospective nationwide cohort study

SETTING: Data were obtained from the Danish Colorectal Cancer Group and the National Patient Registry.

PATIENTS: Patients with colonic cancer undergoing elective resection between 2001 and 2008 were selected.

MAIN OUTCOME MEASURES: The primary outcome was the ability of comorbidity to predict anastomotic leak. Secondary outcomes were 30-day mortality and length of stay. Comorbidity was assessed by the Charlson Comorbidity Index. Multivariable logistic regression and receiver operating characteristics curves were used to adjust for confounding.

RESULTS: The rate of anastomotic leak was 535/8597 (6.2%). The mean (95% CI) Charlson score was 0.83 (0.72–0.94) and 0.63 (0.61–0.66) for patients with and without anastomotic leak, p < 0.001. The Charlson score, as assessed in the multivariable analysis (adjusted OR, 1.07; 95% CI, 0.99–1.15; p = 0.077) and by receiver operating characteristics curves (area under the curve = 0.548), failed to predict anastomotic leak. Thirty-day mortality was 425/8587 (4.9%). In patients with anastomotic leakage, a Charlson score of ≥2 was associated with increased mortality in comparison with a Charlson score of <2 (adjusted HR, 1.58; 95% CI, 1.00–2.51; p = 0.047). Mean length of stay was 8.7 days (95% CI, 8.4–9.2 days) for patients without an anastomotic leak in comparison with 23.3 days (95% CI, 21.5–25.1 days) for patients with anastomotic leak and 25.5 days (95% CI, 21.7–29.3 days) in patients with anastomotic leak and a Charlson score of >2, p < 0.001.

LIMITATIONS: This study is limited by the accuracy of the coding used to generate the Charlson Comorbidity Index and the retrospective study design.

CONCLUSION: Comorbidity failed to predict anastomotic leak, but it was associated with an inferior short-term outcome in patients with this surgical complication.

1 Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark

2 Danish Colorectal Cancer Group, Copenhagen, Denmark

Funding/Support: This study was supported by the I. M. Dæhnfeldt Foundation, the A. P. Møller Foundation, and the Danish Medical Association

Financial Disclosure: None reported.

Poster presentation at the American College of Surgeons Clinical Congress, San Francisco, CA, October 26 to 30, 2014.

Correspondence: Peter-Martin Krarup, M.D., Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Denmark, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark. E-mail:

© 2015 The American Society of Colon and Rectal Surgeons