Risk factors associated with morbidity and mortality in emergency colorectal cancer resections

Introduction: Colorectal cancer is in the third rank in the world in terms of both the number of cancer diagnoses and the cause of cancer-related death. Despite the efforts made for early diagnosis, approximately 25% of the patients are still operated under emergency conditions. The aim of our study is to investigate the risk factors associated with morbidity and mortality in patients who need emergency resection in colorectal cancer in our clinic. Methods Patients who underwent emergency colorectal resection in a single center between 2019 and 2022 and were histopathologically confirmed to have primary colorectal malignant neoplasm were included in this retrospective observational study. Demographics, Charlson comorbidity index, smoking and comorbidity histories, duration of surgery, tumor characteristics and stage, presence of perforation of the cases were examined. Morbidity was defined as Clavien Dindo grade III or higher complication. Risk factors for both morbidity and mortality were first evaluated with univariate analyzes. Then multivariable logistic regression tests were performed for both morbidity and mortaliy. Results The study was conducted with 188 patients, 119(63.3%) of whom were men. The morbidity rate was 36.1%, and the 90-day mortality rate was 23.9%. In multivariate analyzes, factors associated with morbidity risk were age (OR = 3.02, p = 0.009), ASA (OR = 1.01, p = 0.049), duration of surgery (OR = 1.01, p = 0.001), and presence of perforation (OR, 3.24, p = 0.004). Multivariate analyzes for mortality showed significant effect of age (OR, 3.23, p = 0.017), ASA (OR, 5.92, p = 0.009), duration of operation (OR, 1.01, p = 0.007) and the presence of perforation (OR, 3.01, p = 0.013). Conclusion Age (> 70), ASA score (≥ 3), longer operation and presence of perforation are significantly associated with both morbidity and mortality. While age and its effects do not seem as easily modifiable, perforation should be targeted to manage better. Developing algorhytms for early diagnosis, identifying high risk patients and then close perioperative follow-up and intensive treatment are essential for achieving better outcomes.