Introduction Increasingly older patients with co-existing co-morbidities are undergoing hepatectomies for colorectal liver metastases (CRLM).
The primary objective was to ascertain the relationship between comorbidities and outcome (overall survival [OS] and disease free survival [DFS]) for patients undergoing hepatectomies. Secondary objectives included evaluating the effect of comorbidities on complications and length of stay (LOS).
Method Data from a prospectively maintained database was collected for patients undergoing a liver resection for CRLM between 1 January 2005 and 31 December 2012. Patient and tumour demographics, comorbidity status, pathology and outcomes were collected. Charlson comorbidity index (CCI), ASA grade and index disease (ID) systems were used to quantify comorbidities, which were analysed against the primary and secondary outcome measures.
Results The study included 866 patients, with a mean age of 66 years [range 23–91]. Of the sample population, 65.8% were male.
There was a non-significant trend towards poorer survival with increased comorbidity, using the ASA grading system (ASA OS p = 0.07, ASA DFS p = 0.13). CCI showed a significant association with DFS (p = 0.039) but none with OS (p = 0.54). However ID did not show any association with either OS or DFS (ID OS p = 0.53 and ID DFS p = 0.93).
Higher ASA grades and ID scores were more likely to be associated with major complications (Clavien-Dindo ≥3) using χ2(p = 0.02 for both ASA and ID).
Patients with higher ID scores were more likely to have a prolonged LOS (p < 0.01), but no association was found with ASA grade (p = 0.096). CCI did not find any association between LOS (p = 0.31) or complications (p = 0.85).
Conclusion Comorbidities appear to be associated with poorer survival outcomes. ASA grade and ID scores determine post-operative risk more optimally than CCI.
There is an association between increased comorbidities, complication rates and LOS.
Disclosure of interest None Declared.
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