Whelan M1,2, Van Aswegen H1, Roos R1
1University of the Witwatersrand, Department of Physiotherapy, Johannesburg, South Africa, 2Wits University Donald Gordon Medical Centre, Johannesburg, South Africa
Background: The incidence of colorectal cancer has increased and is currently the third most common type of cancer worldwide. Advanced age and the presence of comorbidities often complicate patients' post-operative recovery. Due to advancements in modern medicine, surgery for colorectal cancer is performed on patients that would previously not have been considered as suitable candidates.
Purpose: The primary objective was to describe the demographic, clinical and physical activity profiles of patients who had surgery for colorectal cancer in a private hospital in Johannesburg, South Africa. The secondary objective was to determine the factors that influenced post-operative hospital length of stay and complications.
Methods: The study was a retrospective analysis of data from an existing REDCap database. Data of patients who had been discharged from hospital following surgery for colorectal cancer during the period February 2016 to June 2018 were included. Descriptive statistics were used to summarise the data. Stepwise regression analysis was used to test which factors influenced post-operative outcomes.
Results: The cohort consisted of 50% (n=78/156) female patients and a mean age of 59.1 (SD=13.86) years. Majority of the cohort were non-smokers (n=87, 63.8%). The cohort was overweight when presenting for surgery (median body mass index of 26, IQR:23-30 kg/m2) but the number of meals consumed per day (pre-operatively) was 3 (IQR:2.3-3). The mode of transport used was motor vehicles (n=148, 76.3%) and 62.6% of the cohort were employed (n=97). Most common comorbidities reported were chronic obstructive pulmonary disease (n=13, 8.3%) and diabetes mellitus (n=23, 14.7%). Pre-operatively, majority were fully active (Eastern Cooperative Oncology Group (ECOG) score of 0) or restricted in physically strenuous activities (ECOG score of 1) (n=29; 24.4% and n=45; 37.8% respectively) and had mild systemic disease (American Society of Anaesthesiologists classification of physical health score of 2 (n=51; 56.7%)). Majority of the cohort had open laparotomy procedures (n=83; 62.4%) or laparoscopic procedures (n=43; 32.3%). Eighty four patients (63.6%) presented with post-operative complications. The median hospital length of stay (LOS) was 11 (IQR:7-15) days. Gender and number of meals per day (pre-operatively) explained 96.7% of the variance of hospital LOS (R2=0.97, F change=19.636, p=0.011). The number of meals consumed per day prior to surgery significantly predicted hospital LOS (β=-9.0, p=0.011) as did gender (β=9.5, p=0.03). The results also indicated that age explained 75.6% of the variance of post-operative complications (R2=0.756, F change =15.453, p=0.011). Increased age significantly predicted incidence of post-operative complications (β=0.025, p=0.011).
Conclusion(s): The majority of patients had open laparotomy procedures and many patients presented with post-operative complications of which age was a predictor.
Implications: The results of this study support the use of pre-operative rehabilitation and nutritional input to optimise patients in the older colorectal cancer population to improve post-operative outcomes.
Keywords: Colorectal cancer, patient profile, post-operative outcomes
Funding acknowledgements: South African Medical Research Council, WITS MRC CECRC
Purpose: The primary objective was to describe the demographic, clinical and physical activity profiles of patients who had surgery for colorectal cancer in a private hospital in Johannesburg, South Africa. The secondary objective was to determine the factors that influenced post-operative hospital length of stay and complications.
Methods: The study was a retrospective analysis of data from an existing REDCap database. Data of patients who had been discharged from hospital following surgery for colorectal cancer during the period February 2016 to June 2018 were included. Descriptive statistics were used to summarise the data. Stepwise regression analysis was used to test which factors influenced post-operative outcomes.
Results: The cohort consisted of 50% (n=78/156) female patients and a mean age of 59.1 (SD=13.86) years. Majority of the cohort were non-smokers (n=87, 63.8%). The cohort was overweight when presenting for surgery (median body mass index of 26, IQR:23-30 kg/m2) but the number of meals consumed per day (pre-operatively) was 3 (IQR:2.3-3). The mode of transport used was motor vehicles (n=148, 76.3%) and 62.6% of the cohort were employed (n=97). Most common comorbidities reported were chronic obstructive pulmonary disease (n=13, 8.3%) and diabetes mellitus (n=23, 14.7%). Pre-operatively, majority were fully active (Eastern Cooperative Oncology Group (ECOG) score of 0) or restricted in physically strenuous activities (ECOG score of 1) (n=29; 24.4% and n=45; 37.8% respectively) and had mild systemic disease (American Society of Anaesthesiologists classification of physical health score of 2 (n=51; 56.7%)). Majority of the cohort had open laparotomy procedures (n=83; 62.4%) or laparoscopic procedures (n=43; 32.3%). Eighty four patients (63.6%) presented with post-operative complications. The median hospital length of stay (LOS) was 11 (IQR:7-15) days. Gender and number of meals per day (pre-operatively) explained 96.7% of the variance of hospital LOS (R2=0.97, F change=19.636, p=0.011). The number of meals consumed per day prior to surgery significantly predicted hospital LOS (β=-9.0, p=0.011) as did gender (β=9.5, p=0.03). The results also indicated that age explained 75.6% of the variance of post-operative complications (R2=0.756, F change =15.453, p=0.011). Increased age significantly predicted incidence of post-operative complications (β=0.025, p=0.011).
Conclusion(s): The majority of patients had open laparotomy procedures and many patients presented with post-operative complications of which age was a predictor.
Implications: The results of this study support the use of pre-operative rehabilitation and nutritional input to optimise patients in the older colorectal cancer population to improve post-operative outcomes.
Keywords: Colorectal cancer, patient profile, post-operative outcomes
Funding acknowledgements: South African Medical Research Council, WITS MRC CECRC
Topic: Oncology, HIV & palliative care
Ethics approval required: Yes
Institution: University of the Witwatersrand
Ethics committee: Human Research Ethics Committee (Medical)
Ethics number: M150446
All authors, affiliations and abstracts have been published as submitted.
