Understanding factors in emergency presentation for colorectal cancer surgery (#255)
Background: The Victorian Department of Health 2010/11 state-wide analysis of colorectal cancer (CRC) surgical episodes identified emergency presentation (EP), age over 80 and multiple comorbidities as risk factors impacting on patient outcomes. North Eastern Melbourne Integrated Cancer Service (NEMICS) undertook an exploratory clinical audit to investigate CRC surgery after EP.
Aims: To identify key determinants influencing EP leading to CRC surgery.
Methods: CRC surgery patients after EP were identified in the 2011/12 Victorian Admitted Episode Dataset (VAED). Data collected included prior medical consultations, imaging, referral, symptoms and surgical treatment of CRC.
Results: There were 50 cases identified from three NEMICS hospitals, 30 of which were audited. Median age was 74.5 years. Eight patients had multiple comorbidities (Charlson comorbidity index ≥2). Median length of stay was 12 days.
EP leading to CRC surgery was the first medical contact for nine patients. Five patients had known, untreated CRC. The remaining 16 patients had previously consulted a doctor regarding symptoms. 10/30 (33%) patients had a prior EP or hospital admission for related symptoms, half with two or more encounters. 16/30 had at least one relevant investigation prior to the surgical admission. 17 patients had a self-presented EP and 13 were referred by GP or specialist.
Three patients presented with bowel obstruction and perforation; two with peritonitis and perforation; five with perforation alone and 17 with obstruction alone. 23/30 patients had emergency surgery whilst the remaining seven were stabilised in hospital until elective surgery. 19 (63%) patients had stage III or IV CRC.
Discussion: CRC EP was effectively identified by the search strategy. All but 10% of the cases presented with obstruction +/- perforation. For only 30% of cases was the EP the first presentation with CRC symptoms, suggesting that more effective earlier intervention might avert emergency presentation in these cases and possibly improve outcomes.