Association of Comorbidity with Anastomotic Leak, 30-day Mortality, and Length of Stay in Elective Surgery for Colonic Cancer

Abstract

Comorbidity has a negative influence on the long-term prognosis in patients with colorectal cancer, whereas its impact on the postoperative course is less clear. The aim of this study was to investigate the influence of comorbidity on anastomotic leak and short-term outcomes after resection for colonic cancer. This is a retrospective nationwide cohort study : Data were obtained from the Danish Colorectal Cancer Group and the National Patient Registry. Patients with colonic cancer undergoing elective resection between 2001 and 2008 were selected. The primary outcome was the ability of comorbidity to predict anastomotic leak. Secondary outcomes were 30-day mortality and length of stay. Comorbidity was assessed by the Charlson Comorbidity Index. Multivariable logistic regression and receiver operating characteristics curves were used to adjust for confounding. The rate of anastomotic leak was 535/8597 (6.2%). The mean (95% CI) Charlson score was 0.83 (0.72-0.94) and 0.63 (0.61-0.66) for patients with and without anastomotic leak, p < 0.001. The Charlson score, as assessed in the multivariable analysis (adjusted OR, 1.07; 95% CI, 0.99-1.15; p = 0.077) and by receiver operating characteristics curves (area under the curve = 0.548), failed to predict anastomotic leak. Thirty-day mortality was 425/8587 (4.9%). In patients with anastomotic leakage, a Charlson score of ≥ 2 was associated with increased mortality in comparison with a Charlson score of 2, p < 0.001. This study is limited by the accuracy of the coding used to generate the Charlson Comorbidity Index and the retrospective study design. Comorbidity failed to predict anastomotic leak, but it was associated with an inferior short-term outcome in patients with this surgical complication.