eP301 - Outcomes of Colorectal Surgery in Nonagenarian Patients: A Single Center Retrospective Study

Purpose/Background: As the aging population increases globally, an increased number of geriatric patients are undergoing colorectal surgery. Nonagenarians are an increasing subset of this population, and the safety and efficacy of colorectal surgery in this population remains a subject for debate. This study aims to investigate the outcomes of colorectal surgery in nonagenarians and identify potential factors that may influence the surgical outcomes in nonagenarians undergoing colorectal surgery.Methods/Interventions: After IRB approval, charts were reviewed retrospectively in a cohort of nonagenarian patients (YOA 90-99) who underwent colorectal surgery between 2018 to October 2023. Patient demographics, ASA score, indication for surgery, Eastern Cooperative Oncology Group (ECOG) performance status, complications, operative time, length of stay, and mortality rate was reviewed. A multivariate analysis was then performed on the data.Results/Outcomes: Out of the 29 patients, 17 were females. The average age of these patients was 92.8 years, with a standard deviation of ± 2.67 years. Out of the total, ten patients (34.5%) underwent emergency surgery and the remaining nineteen patients (65.5%) had an elective procedure (Table 1). As for the 30-day mortality, there was no significant difference between elective and emergency procedures. The 90-day mortality for elective and emergency surgeries was 3.4% (1 out of 29) and 20.7% (6 out of 29), respectively (P < 0.05), (Table 2). The mortality rate at 90 days is significantly higher in patients who have a Comprehensive Complication Index (CCI) 9 or greater (p < 0.001). Twenty patients were diagnosed with colon cancer, of which nineteen had invasive adenocarcinoma and one had a neuroendocrine tumor. All the cancer margins were negative and none of the patients required reoperation. Surgery indications, transfusions, ASA scores, gender, and cancer stages did not influence the 90-day mortality rates. Early complications were observed in twelve patients, encompassing pulmonary complications, readmissions for ileus and fatigue, upper gastrointestinal bleeding, urinary tract infections, acute kidney injury, and cholecystitis. The most common early complication was pulmonary issues, which occurred in four patients, accounting for 13.8% of cases.Conclusion/

Discussion: Despite the challenges posed by advanced age and associated comorbidities, colorectal procedures can be performed in this population safely. Identification of high risk factors is crucial to improve outcomes in nonagenarians undergoing colorectal surgery. The most common postoperative complication is pulmonary in nature. The mortality rate over a three-month period increases in association with emergent surgery and a high CCI. Tailoring perioperative care in line with their comorbidities and functional status is essential to optimize outcomes as well. Further trials are warranted to enhance the overall quality of care for nonagenarian patients undergoing colorectal surgery."Table 1, Demographics

Demographics of nonagenarian patients undergoing colorectal surgery
Table 2, 90 day mortality

90 day mortality rates in nonagenarians undergoing colorectal surgery. "