Screening and systematic follow-up for cardiopulmonary comorbidity in elective surgery for colorectal cancer

a randomised feasibility study

Hans B Rahr, Susanna Streym, Charlotte G Kryh-Jensen, Helene T Hougaard, Anne S Knudsen, Steffen H Kristensen, Ejler Ejlersen

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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Resumé

BACKGROUND: One third of patients with colorectal cancer (CRC) have comorbidity, which impairs their postoperative outcomes. Scoring systems may predict mortality, but there is limited evidence of effective interventions in high-risk patients. Our aim was to test a trial setup to assess the effect of extra postoperative medical visits and follow-up on 1-year mortality and other outcomes in patients with cardiopulmonary risk factors undergoing elective surgery for colorectal tumours.

METHODS: Patients preoperatively screened positive for cardiopulmonary comorbidity were eligible. On postoperative day 4, they were randomised to either routine follow-up (RFU) or RFU with one extra medical visit and additional visits to the Cardiology and Respiratory Medicine Clinics 1 and 3 months postoperatively. The primary outcome measure was 1-year mortality; secondary outcome measures were length of stay (LOS), complications, and readmissions.

RESULTS: Of 673 screened patients 326 (48%) were found eligible, 108 declined participation, and 198 were randomised. Postoperative medical problems and/or need for intervention were found in 15-23% of the patients at the extra medical visits. The 90-day mortality was 0 and the 1-year mortality only 2.6% with no differences between the two groups. LOS and complication rates did not differ, but there were significantly fewer readmissions in the intervention group.

CONCLUSIONS: The 1-year mortality after elective CRC surgery was low, even in the presence of cardiopulmonary risk factors. There was no evidence of reduced mortality with additional medical follow-up in these patients.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02328365 registered 31 December 2014 (retrospectively registered).

OriginalsprogEngelsk
Artikelnummer127
TidsskriftWorld Journal of Surgical Oncology
Vol/bind17
Antal sider10
ISSN1477-7819
DOI
StatusUdgivet - 22. jul. 2019

Fingeraftryk

Feasibility Studies
Comorbidity
Colorectal Neoplasms
Length of Stay
Outcome Assessment (Health Care)
Pulmonary Medicine
Colorectal Surgery

Citer dette

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title = "Screening and systematic follow-up for cardiopulmonary comorbidity in elective surgery for colorectal cancer: a randomised feasibility study",
abstract = "BACKGROUND: One third of patients with colorectal cancer (CRC) have comorbidity, which impairs their postoperative outcomes. Scoring systems may predict mortality, but there is limited evidence of effective interventions in high-risk patients. Our aim was to test a trial setup to assess the effect of extra postoperative medical visits and follow-up on 1-year mortality and other outcomes in patients with cardiopulmonary risk factors undergoing elective surgery for colorectal tumours.METHODS: Patients preoperatively screened positive for cardiopulmonary comorbidity were eligible. On postoperative day 4, they were randomised to either routine follow-up (RFU) or RFU with one extra medical visit and additional visits to the Cardiology and Respiratory Medicine Clinics 1 and 3 months postoperatively. The primary outcome measure was 1-year mortality; secondary outcome measures were length of stay (LOS), complications, and readmissions.RESULTS: Of 673 screened patients 326 (48{\%}) were found eligible, 108 declined participation, and 198 were randomised. Postoperative medical problems and/or need for intervention were found in 15-23{\%} of the patients at the extra medical visits. The 90-day mortality was 0 and the 1-year mortality only 2.6{\%} with no differences between the two groups. LOS and complication rates did not differ, but there were significantly fewer readmissions in the intervention group.CONCLUSIONS: The 1-year mortality after elective CRC surgery was low, even in the presence of cardiopulmonary risk factors. There was no evidence of reduced mortality with additional medical follow-up in these patients.TRIAL REGISTRATION: ClinicalTrials.gov NCT02328365 registered 31 December 2014 (retrospectively registered).",
keywords = "Colorectal cancer, Comorbidity, Postoperative complications, Risk assessment",
author = "Rahr, {Hans B} and Susanna Streym and Kryh-Jensen, {Charlotte G} and Hougaard, {Helene T} and Knudsen, {Anne S} and Kristensen, {Steffen H} and Ejler Ejlersen",
year = "2019",
month = "7",
day = "22",
doi = "10.1186/s12957-019-1668-7",
language = "English",
volume = "17",
journal = "World Journal of Surgical Oncology",
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Screening and systematic follow-up for cardiopulmonary comorbidity in elective surgery for colorectal cancer : a randomised feasibility study. / Rahr, Hans B; Streym, Susanna; Kryh-Jensen, Charlotte G; Hougaard, Helene T; Knudsen, Anne S; Kristensen, Steffen H; Ejlersen, Ejler.

I: World Journal of Surgical Oncology, Bind 17, 127, 22.07.2019.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Screening and systematic follow-up for cardiopulmonary comorbidity in elective surgery for colorectal cancer

T2 - a randomised feasibility study

AU - Rahr, Hans B

AU - Streym, Susanna

AU - Kryh-Jensen, Charlotte G

AU - Hougaard, Helene T

AU - Knudsen, Anne S

AU - Kristensen, Steffen H

AU - Ejlersen, Ejler

PY - 2019/7/22

Y1 - 2019/7/22

N2 - BACKGROUND: One third of patients with colorectal cancer (CRC) have comorbidity, which impairs their postoperative outcomes. Scoring systems may predict mortality, but there is limited evidence of effective interventions in high-risk patients. Our aim was to test a trial setup to assess the effect of extra postoperative medical visits and follow-up on 1-year mortality and other outcomes in patients with cardiopulmonary risk factors undergoing elective surgery for colorectal tumours.METHODS: Patients preoperatively screened positive for cardiopulmonary comorbidity were eligible. On postoperative day 4, they were randomised to either routine follow-up (RFU) or RFU with one extra medical visit and additional visits to the Cardiology and Respiratory Medicine Clinics 1 and 3 months postoperatively. The primary outcome measure was 1-year mortality; secondary outcome measures were length of stay (LOS), complications, and readmissions.RESULTS: Of 673 screened patients 326 (48%) were found eligible, 108 declined participation, and 198 were randomised. Postoperative medical problems and/or need for intervention were found in 15-23% of the patients at the extra medical visits. The 90-day mortality was 0 and the 1-year mortality only 2.6% with no differences between the two groups. LOS and complication rates did not differ, but there were significantly fewer readmissions in the intervention group.CONCLUSIONS: The 1-year mortality after elective CRC surgery was low, even in the presence of cardiopulmonary risk factors. There was no evidence of reduced mortality with additional medical follow-up in these patients.TRIAL REGISTRATION: ClinicalTrials.gov NCT02328365 registered 31 December 2014 (retrospectively registered).

AB - BACKGROUND: One third of patients with colorectal cancer (CRC) have comorbidity, which impairs their postoperative outcomes. Scoring systems may predict mortality, but there is limited evidence of effective interventions in high-risk patients. Our aim was to test a trial setup to assess the effect of extra postoperative medical visits and follow-up on 1-year mortality and other outcomes in patients with cardiopulmonary risk factors undergoing elective surgery for colorectal tumours.METHODS: Patients preoperatively screened positive for cardiopulmonary comorbidity were eligible. On postoperative day 4, they were randomised to either routine follow-up (RFU) or RFU with one extra medical visit and additional visits to the Cardiology and Respiratory Medicine Clinics 1 and 3 months postoperatively. The primary outcome measure was 1-year mortality; secondary outcome measures were length of stay (LOS), complications, and readmissions.RESULTS: Of 673 screened patients 326 (48%) were found eligible, 108 declined participation, and 198 were randomised. Postoperative medical problems and/or need for intervention were found in 15-23% of the patients at the extra medical visits. The 90-day mortality was 0 and the 1-year mortality only 2.6% with no differences between the two groups. LOS and complication rates did not differ, but there were significantly fewer readmissions in the intervention group.CONCLUSIONS: The 1-year mortality after elective CRC surgery was low, even in the presence of cardiopulmonary risk factors. There was no evidence of reduced mortality with additional medical follow-up in these patients.TRIAL REGISTRATION: ClinicalTrials.gov NCT02328365 registered 31 December 2014 (retrospectively registered).

KW - Colorectal cancer

KW - Comorbidity

KW - Postoperative complications

KW - Risk assessment

U2 - 10.1186/s12957-019-1668-7

DO - 10.1186/s12957-019-1668-7

M3 - Journal article

VL - 17

JO - World Journal of Surgical Oncology

JF - World Journal of Surgical Oncology

SN - 1477-7819

M1 - 127

ER -