Emergency surgery for colonic cancer in a defined population

Abstract

Abstract Background The aim of this study was to identify risk factors in emergency surgery for colonic cancer in a large population and to investigate the economic impact of such surgery. Methods Data from the colonic cancer registry (1997–2001) of the Uppsala/Örebro Regional Oncological Centre were analysed and classified by hospital category. Some 3259 patients were included; 806 had an emergency and 2453 an elective procedure. Data for calculating effects on health economy were derived from a national case-costing register. Results Patients who had emergency surgery had more advanced tumours and a lower survival rate than those who had an elective procedure (5-year survival rate 29·8 versus 52·4 per cent; P < 0·001). There was a stage-specific difference in survival, with poorer survival both for patients with stage I and II tumours and for those with stage III tumours after emergency compared with elective surgery (P < 0·001). Emergency surgery was associated with a longer hospital stay (mean 18·0 versus 10·0 days; P < 0·001) and higher costs (relative cost 1·5 (95 per cent confidence interval 1·4 to 1·6)) compared with elective surgery. The duration of hospital stay was the strongest determinant of cost (r2 = 0·52, P < 0·001). Conclusion Emergency surgery for colonic cancer is associated with a stage-specific increase in mortality rate.