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Original Investigation | SURGICAL CARE OF THE AGING POPULATION

Colorectal Cancer Resections in the Aging US Population:  A Trend Toward Decreasing Rates and Improved Outcomes

Mehraneh D. Jafari, MD1; Fariba Jafari, BS1; Wissam J. Halabi, MD1; Vinh Q. Nguyen, PhD1; Alessio Pigazzi, MD, PhD1; Joseph C. Carmichael, MD1; Steven D. Mills, MD1; Michael J. Stamos, MD1
[+] Author Affiliations
1Department of Surgery, University of California, Irvine School of Medicine, Orange
JAMA Surg. 2014;149(6):557-564. doi:10.1001/jamasurg.2013.4930.
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Importance  The incidence of colorectal cancer in elderly patients is likely to increase, but there is a lack of large nationwide data regarding the mortality and morbidity of colorectal cancer resections in the aging population.

Objective  To examine the surgical trends and outcomes of colorectal cancer treatment in the elderly.

Design, Setting, and Participants  A review of operative outcomes for colorectal cancer in the United States was conducted in a Nationwide Inpatient Sample from January 1, 2001, through December 31, 2010. Patients were stratified within age groups of 45 to 64, 65 to 69, 70 to 74, 75 to 79, 80 to 84, and 85 years and older. Postoperative complications and yearly trends were analyzed. A multivariate logistic regression was used to compare in-hospital mortality and morbidity between individual groups of patients 65 years and older and those aged 45 to 64 years while controlling for sex, comorbidities, procedure type, diagnosis, and hospital status.

Main Outcomes and Measures  In-hospital mortality and morbidity.

Results  Among the estimated 1 043 108 patients with colorectal cancer sampled, 63.8% of the operations were performed on those 65 years and older and 22.6% on patients 80 years and older. Patients 80 years and older were 1.7 times more likely to undergo urgent admission than those younger than 65 years. Patients younger than 65 years accounted for 46.0% of the laparoscopies performed in the elective setting compared with 14.1% for patients 80 years and older. Mortality during the 10 years decreased by a mean of 6.6%, with the most considerable decrease observed in the population 85 years and older (9.1%). Patients 80 years and older had an associated $9492 higher hospital charge and an increased 2½-day length of stay vs patients younger than 65 years. Compared with patients aged 45 to 64 years, higher risk-adjusted in-hospital mortality was observed in patients with advancing age: 65 to 69 years (odds ratio, 1.32; 95% CI, 1.18-1.49), 70 to 74 years (2.02; 1.82-2.24), 75 to 79 years (2.51; 2.28-2.76), 80 to 84 years (3.15; 2.86-3.46), and 85 years and older (4.72; 4.30-5.18) (P < .01). Compared with patients aged 45 to 64 years, higher risk-adjusted morbidity was noted in those with advancing age: 65 to 69 years (odds ratio, 1.25; 95% CI, 1.21-1.29), 70 to 74 years (1.40; 1.36-1.45), 75 to 79 years (1.54; 1.49-1.58), 80 to 84 years (1.68; 1.63-1.74), and 85 years and older (1.96; 1.89-2.03) (P < .01).

Conclusions and Relevance  Most operations for colorectal cancer are performed on the aging population, with an overall decrease in the number of cases performed. Despite the overall improved mortality seen during the past 10 years, the risk-adjusted mortality and morbidity of the elderly continue to be substantially higher than that for the younger population.

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Figure 1.
Number of Colorectal Cancer Resections

Total number of colorectal cancer resections performed in the United States from January 1, 2001, through December 31, 2010.

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Figure 2.
Improved Mortality in the Elderly

Decrease in mortality rates as demonstrated by the linear line comparing patients in the group 85 years and older with the control group (aged 45-64 years).

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