Short-term outcomes of colorectal cancer surgery in older patients. A novel nomogram predicting postoperative morbi-mortality.

Purpose: To analyze short-term outcomes in curative-intent colorectal cancer surgery and determine risk factors for postoperative complications and mortality. Methods Retrospective study conducted at a single tertiary university institution. All adult patients undergoing colorectal surgery from January 2010 to December 2019 were included. Patients were stratified by age into two groups: <75 years and ≥ 75 years. Primary outcome was the influence of age on 30-day complications and mortality. Independent risk factors for postoperative adverse events or mortality were analyzed and two novel nomograms were constructed. Results Of the 1486 patients included, 580 were older (≥ 75 years). Older subjects presented more comorbidities and tumors were located mainly in right colon (45.7%). After matching, no between-group differences in surgical postoperative complications were observed. The 30-day mortality rate was 5.3% for the older and 0.8% for the non-older group (p < 0.001). In multivariable analysis, the independent risk factors for postoperative complications were peripheral vascular disease, chronic pulmonary disease, severe liver disease, postoperative transfusion and surgical approach. Independent risk factors for 30-day mortality were age ≥ 80 years, cerebrovascular disease, severe liver disease and postoperative transfusion. The model was internally and externally validated, showing high accuracy. Conclusion Patients aged ≥ 75 years had similar postoperative complications but higher 30-day mortality than their younger counterparts. Patients with peripheral vascular disease, chronic pulmonary disease or severe liver disease should be informed of higher postoperative complications. But patients aged ≥ 80 suffering cerebrovascular disease, severe liver disease or needing postoperative transfusion should be warned of significantly increased risk of postoperative mortality.