Short-term postoperative outcomes of colorectal cancer among patients with chronic liver disease: a national population-based study

Abstract

Objective: Patients with colorectal carcinoma (CRC) with pre-existing chronic liver disease (CLD) had a significantly higher 30-day mortality after CRC surgery compared with healthy controls. This study investigated the factors associated with postoperative complications and in-hospital mortality in patients with CRC with coexisting CLD (excluding cirrhosis) who underwent colorectal surgery.

Design: A retrospective, observational, population-based study.

Setting: Data were sourced from the National Inpatient Sample database, a part of the Healthcare Cost and Utilisation Project.

Participants: This study analysed 7463 inpatients with CRC who underwent colorectal surgery on admission between 2005 and 2014.

Primary and secondary outcome measures: The primary endpoint of this study was the prevalence of postoperative complications, and the secondary endpoint was in-hospital mortality.

Results: In the CLD group, 36.27% of patients had chronic hepatitis C, 28.36% had non-alcoholic fatty liver disease and 31.19% had other types of CLD. The median hospital stay was 7.0 (5.0-10.0) days in patients with no postoperative complications vs 17.0 (10.0-26.0) days, 8.0 (6.0-12.0) days, 8.0 (6.0-17.0) days, 9.0 (8.0-14.0) days and 10.5 (7.0-17.0) days for patients with postoperative infection, postoperative bleeding, cardiac arrest/heart failure, respiratory complications and digestive complications, respectively (all p<0.05). The presence of CLD was significantly associated with higher risk of postoperative bleeding (adjusted OR (aOR)=1.64, 95% CI 1.15 to 2.34, p=0.007). The presence of CLD (aOR=1.98, 95% CI 1.39 to 2.82, p<0.001) and length of hospital stay (aOR=1.06, 95% CI 1.04 to 1.08, p<0.001) were significantly associated with higher risk of in-hospital mortality. However, hyperlipidaemia was associated with a significantly lower risk of mortality (aOR=0.46, 95% CI 0.28 to 0.75, p=0.002).

Conclusions: Postoperative complications prolonged the length of hospital stay. The presence of CLD and hyperlipidaemia were important factors impacting postoperative complications and in-hospital mortality in patients with CRC with underlying CLD.

Keywords: Healthcare Cost and Utilization Project (HCUP); National Inpatient Sample (NIS); chronic liver disease; colorectal cancer; mortality; short-term morbidity.