| A Novel Nomogram Accurately Quantifies the Risk of Mortality in Elderly Patients Undergoing Colorectal Surgery. | |
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MedLine Citation:
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PMID: 23001078 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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OBJECTIVE:: The ability to accurately predict postoperative mortality is expected to improve preoperative decisions for elderly patients considered for colorectal surgery. METHODS:: Patients undergoing colorectal surgery were identified from the National Surgical Quality Improvement Program database (2005-2007) and stratified as elderly (>70 years) and nonelderly (<70 years). Univariate analysis of preoperative risk factors and 30-day mortality and morbidity were analyzed on 70% of the population. A nomogram for mortality was created and tested on the remaining 30%. RESULTS:: Of 30,900 colorectal cases, 10,750 were elderly (>70 years). Mortality increased steadily with age (0.5% every 5 years) and at a faster rate (1.2% every 5 years) after 70 years, which defined "elderly" in this study. Elderly (mean age: 78.4 years) and nonelderly patients (52.8 years) had mortality of 7.6% versus 2.0% and a morbidity of 32.8% versus 25.7%, respectively. Elderly patients had greater preoperative comorbidities including chronic obstructive pulmonary disease (10.5% vs 3.8%), diabetes (18.7% vs 11.1%), and renal insufficiency (3.3% vs 2.1%). A multivariate model for 30-day mortality and nomogram were created. Increasing age was associated with mortality [age >70 years: odds ratio (OR) = 2.0 (95% confidence interval (CI): 1.7-2.4); >85 years: OR = 4.3 (95% CI: 3.3-5.5)]. The nomogram accurately predicted mortality, including very high-risk (>50% mortality) with a concordant index for this model of 0.89. CONCLUSIONS:: Colorectal surgery in elderly patients is associated with significantly higher mortality. This novel nomogram that predicts postoperative mortality may facilitate preoperative treatment decisions. |
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Authors:
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Ravi P Kiran; Vikram Attaluri; Jeff Hammel; James Church |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-9-21 |
Journal Detail:
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Title: Annals of surgery Volume: - ISSN: 1528-1140 ISO Abbreviation: Ann. Surg. Publication Date: 2012 Sep |
Date Detail:
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Created Date: 2012-9-24 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0372354 Medline TA: Ann Surg Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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