Introduction Emergency surgery for colorectal cancer (CRC) conveys high postoperative morbidity and mortality. The aim of this study is to identify patient groups at high risk of emergency presentation and quantify their overall survival.
Method All patients diagnosed with colorectal cancer between the year 1997–2011 were identified from the Hospital Episode Statistics (HES) database. Logistic regression analyses were undertaken to identify patient groups at risk of undergoing emergency surgery for colorectal cancer at first presentation. Survival plots using multivariable cox proportional hazard analyses were generated.
Results Over this time period, 286,591 patients underwent resection for CRC, 69,718 (24.3%) of which were as emergencies. While, the overall rate of emergency CRC resection has significantly decreased from 29.5% in 1997 to 16.5% in 17.2% in 2011 (p < 0.001), certain patient groups continue to be at risk of undergoing colorectal cancer resection as an emergency. Elderly patients (>79 yrs old) are 55% more likely to require emergency surgery (OR 1.55, CI: 1.50–1.60, p < 0.001) compared to <55 year olds. Similarly patients from a socially deprived background are 64% more likely to undergo emergency surgery than affluent patients (OR 1.64, CI: 1.50–1.80, p < 0.001). Patients from the Black Afro-Caribbean community were also at increased risk compared to White British patients (OR 1.36, CI: 1.21–1.66, p < 0.001). Long-term survival (5-year) remains poor in patients who have emergency surgery even when adjusting for immediate (90-day) post operative mortality (emergency patients HR 1.64, CI 1.63–1.67, p < 0.001). In the screening age population (60–69 years old), there was a significant drop in emergency presentation (23.4% to 14.9%, p < 0.001) before and after the implementation in screening in 2006.
Conclusion Whilst the overall rate of emergency colorectal cancer surgery is reducing, elderly patients, those from a socioeconomically deprived background and Black Afro-Caribbean patients remain at high risk of emergency attendance. Post-operative morbidity and mortality remains high in emergency presenters and 5-year survival in this patient group remains poor. Targeting screening of these high-risk patient groups is essential to reduce the number of patients attending as an emergency further.
Disclosure of interest None Declared.
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