What is the optimal risk scoring for predicting complications after colorectal surgery in elderly patients?

• Published in: International journal of surgery open 2019, Vol.21, p.52-57
• Main Authors: Inoue, Koetsu, Ueno, Tatsuya, Akishige, Naoki, Soeta, Toshihiro, Tsuchiya, Takahiro, Nakayama, Shun, Shima, Kentaro, Goto, Shinji, Takahashi, Michinaga, Naitoh, Takeshi, Naito, Hiroo
• Format: Article
• Language: English
• Subjects: Colorectal cancer; Elderly patient; Risk scoring
• ISSN: 2405-8572; 2405-8572
• DOI: 10.1016/j.ijso.2019.11.007

Although several risk scoring systems that predict postoperative complication incidence are available, the optimal scoring tool for elderly colorectal cancer patients remains unknown. Records of 659 patients underwent surgery for colorectal cancer were retrospectively reviewed, and 130 patients aged >80 years were divided into two groups according to postoperative complications (Clavien-Dindo classification ≥ grade II) as Complication group and Non-complication group.Scoring systems such as the Surgical Apgar score (SAS), and the Prognostic nutritional index (PNI), and sections of the Physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM; physiological score (PS-P), and operative severity score (OS-P)), the Colorectal POSSUM (CR-POSSUM; physiological score (PS-CP) and operative severity score (OS-CP)), and Estimating the physiologic ability and surgical stress score (E-PASS; preoperative risk score (PRS), surgical stress score (SSS) and comprehensive risk score (CRS)) were analyzed. The PS-P, PRS, and CRS were significantly different between the two groups in univariate analysis. Area under the Receiver Operating Characteristic Curve of PRS was the highest among the scoring systems. Multivariate analysis also showed PRS was a useful risk scoring tool. PRS may be useful for predicting the occurrence of complications for colorectal cancer in elderly patients. •We assessed the usability of risk scoring tools in elderly colorectal cancer patients.•PRS over 0.659 was an independent risk factor of postoperative complications.•As PRS can be calculated preoperatively, PRS scores might guide decisions on whether to perform surgery or not.