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Outcomes after rectal cancer surgery in elderly nursing home residents.
MedLine Citation:
PMID:  23135580     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: : As the population ages, an increasing number of elderly persons will undergo surgery for rectal cancer. The use of sphincter-sparing surgery in frail older adults is controversial.
OBJECTIVE: : The aim of this study was to examine mortality and bowel function after proctectomy in nursing home residents.
DESIGN: : This is a retrospective cohort study.
SETTING: : This investigation was conducted in nursing homes in the United States contracted with the Center for Medicare and Medicaid Services.
PATIENTS: : Nursing home residents age 65 and older undergoing proctectomy for rectal cancer (2000-2005) were included.
MAIN OUTCOME MEASURES: : The primary outcomes measured were fecal incontinence and the 1-year mortality rate.
RESULTS: : Operative mortality was 18% after proctectomy with permanent colostomy and 13% after sphincter-sparing proctectomy (adjusted relative risk, 1.25 (95% CI 0.90-1.73), p = 0.188). One-year mortality was high: 40% after sphincter-sparing proctectomy and 51% after proctectomy with permanent colostomy (adjusted hazard ratio 1.32 (95% CI 1.09-1.60), p = 0.004). After sphincter-sparing proctectomy, 37% of residents were incontinent of feces. Residents with the poorest functional status (Minimum Data Set-Activities of Daily Living quartile 4) were significantly more likely to be incontinent of feces than residents with the best functional status (Minimum Data Set-Activities of Daily Living quartile 1) (76% vs 13%, adjusted relative risk 3.28 (95% CI 1.74- 6.18), p= 0.0002). Fecal incontinence was also associated with dementia (adjusted relative risk 1.55 (95% CI 1.15-2.09), p = 0.004) and renal failure (adjusted relative risk 1.93 (95% CI 1.10-3.38), p = 0.022).
LIMITATIONS: : Measures of fecal incontinence in nursing home registries are not as well studied as those commonly used in clinical practice.
CONCLUSIONS: : Sphincter-sparing proctectomy in nursing home residents is frequently associated with postoperative fecal incontinence and should be considered only for continent patients with good functional status.
Emily Finlayson; Shoujun Zhao; Madhulika G Varma
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  55     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-08     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1229-35     Citation Subset:  IM    
1 Phillip R. Lee Institute of Health Policy Studies, University of California, San Francisco, California 2 Department of Surgery, University of California, San Francisco, California.
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