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Cited by 345Colorectal Cancer Surgical TreatmentsSurgical site infection preventionCardiac, Anesthesia and Surgical Outcomes

Infectious Postoperative Complications Decrease Long-term Survival in Patients Undergoing Curative Surgery for Colorectal Cancer: A Study of 12,075 Patients

Artinyan, Avo, Orcutt, Sonia T., Anaya, Daniel A., Richardson, Peter, Chen, G. John, Berger, David H.·2015·Annals of Surgery
DOI 10.1097/sla.0000000000000854
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Abstract

In Brief Objective: We sought to characterize the effect of postoperative complications on long-term survival after colorectal cancer (CRC) resection. Background: The impact of early morbidity on long-term survival after curative-intent CRC surgery remains controversial. Methods: The Veterans Affairs Surgical Quality Improvement Program and Central Cancer Registry databases were linked to acquire perioperative and cancer-specific data for 12,075 patients undergoing resection for nonmetastatic CRC (1999–2009). Patients were categorized by presence of any complication within 30 days and by type of complication (noninfectious vs infectious). Univariate and multivariate survival analyses adjusted for patient, disease, and treatment factors were performed, excluding early deaths (<90 days). Subset analysis was performed to determine the specific impact of severe postoperative infections. Results: The overall morbidity and infectious complication rates were 27.8% and 22.5%, respectively. Patients with noninfectious postoperative complications were older, had lower preoperative serum albumin, had worse functional status, and had higher American Society of Anesthesiologists scores than patients with infectious complications and without complications (all P < 0.001). The presence of any complication was independently associated with decreased long-term survival [hazard ratio, 1.24; 95% confidence interval (1.15–1.34)]. Multivariate analysis by complication type demonstrated increased risk only with infectious complications [hazard ratio, 1.31; 95% confidence interval (1.21–1.42)]. Subset analysis demonstrated this effect predominantly in patients with severe infections [hazard ratio, 1.41; 95% confidence interval (1.15–1.73)]. Conclusions: The presence of postoperative complications after CRC resection is associated with decreased long-term survival, independent of patient, disease, and treatment factors. The impact on long-term outcome is primarily driven by infectious complications, particularly severe postoperative infections. The Veterans Affairs Surgical Quality Improvement Program and Central Cancer Registry nationwide databases were systematically linked. We have demonstrated that postoperative complications after colorectal cancer resection are associated with decreased long-term survival excluding early mortality, and that this effect is primarily driven by infectious complications, particularly severe postoperative infections.

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Authors
Artinyan, A., Orcutt, S. T., Anaya, D. A., Richardson, P., Chen, G. J., & Berger, D. H.
Affiliations
  • Michael E. DeBakey VA Medical Center (US)
  • Baylor College of Medicine (US)
Corresponding author
  • Artinyan, Avo
  • Anaya, Daniel A.
  • Berger, David H.
ORCID
Venue
Annals of Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2015-03
Volume
261
Issue
3
Pages
497-505
ISSN
0003-4932 (ISSN-L)
DOI
10.1097/sla.0000000000000854
OpenAlex
W1990185848
Cited by
345
References
37
Citations by year
2026: 20 · 2025: 25 · 2024: 33 · 2023: 28 · 2022: 37 · 2021: 43 · 2020: 37 · 2019: 28 · 2018: 30 · 2017: 28 · 2016: 22 · 2015: 10 · 2014: 4
FWCI
10.30
Type
journal article
Language
en
Open access
closed
Locations
  • Annals of Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
  • Health Sciences › Medicine › Surgery › Surgical site infection prevention
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
Keywords
colorectal cancer, postoperative complications, infectious complications, long-term survival, colorectal resection, non-infectious complications, postoperative infection, curative surgery
MeSH terms
Aged, Female, Hospitals, Veterans, Humans, Infections, Male, Neoplasm Staging, Postoperative Complications, Prognosis, Registries, Risk Factors, Colorectal Neoplasms, Survival Rate

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