QS204 - Predictors of Postoperative Morbidity in Young Patients Undergoing Elective Colorectal Surgery: A Retrospective Cohort Study

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Purpose/Background: There is an increasing proportion of colorectal diseases presenting in patients under the age of 50. As such, the number of young patients requiring colorectal surgery has grown significantly. Yet, most data identifying perioperative risk factors pertain mostly to all-comers or elderly patients. There are a lack of data concerning young patients specifically. We designed this population-level retrospective cohort study to analyze a large cohort of young patients undergoing elective colorectal surgery through the American College of Surgeons (ACS) National Quality Improvement Program (NSQIP) database to identify risk factors for postoperative morbidity that are specific to young patients.

Methods/Interventions: Adult patients between the ages of 18 and 49 years undergoing elective colectomy and/or proctectomy for colorectal cancer, diverticular disease, and/or inflammatory bowel disease (IBD) between 2016 and 2022 were identified in the ACS-NSQIP database utilizing Current Procedure Terminology (CPT) codes and International Classification of Diseases, Tenth Revision (ICD-10) codes. Patients were excluded if they had an American Society of Anesthesiologists (ASA) classification of five or greater, had sepsis preoperatively, and/or were not receiving a general anesthetic. The primary outcome was 30-day major postoperative morbidity. Secondary outcomes included 30-day readmission, 30-day reoperation, and prolonged length of stay (LOS). Multivariable regression models were fit for each outcome.

Results/Outcomes: Overall, 50,105 patients were included. The majority of patients were male (n=27,228, 54.3%), white (n=36,152, 72.2%), and had body mass indices less than 30 kg/m2 (n=32,409, 64.7%). The most common diseases processes were IBD (n=23,288, 46.5%), followed by colorectal cancer (n=16,459, 32.9%), and diverticular disease (n=10,358, 20.7%). Most patients underwent colectomy with primary anastomosis (n=32,100, 64.1%) and 14.9% (n=7,480) underwent proctectomy. Major postoperative morbidity occurred in 10.7% (n=5,359) of patients. Significant predictors of 30-day postoperative morbidity included modified frailty index-5 (odds ratio [OR] 1.23, 95% confidence interval (CI) 1.13-1.33), smoking (OR 1.29, 95%CI 1.20-1.39), immunosuppression (OR 1.17, 95%CI 1.08-1.26), ASA class (class I [reference]; class II OR 1.17, 95%CI 0.95-1.45; class III OR 1.45, 95%CI 1.16-1.80; class IV OR 1.97, 95%CI 1.42-2.72) operative time (OR 1.01, 95%CI 1.00-1.01), and undergoing proctectomy (OR 1.56, 95%CI 1.43-1.71). Minimally invasive operative approaches were protective (OR 0.63, 95%CI 1.64-2.03). Patients who were smokers and patients undergoing proctectomy were also at significantly increased risk of readmission (OR 1.24, 95%CI 1.14-1.36; OR 2.26, 95%CI 2.04-2.52), reoperation (OR 1.19, 95%CI 1.04-1.36; OR 1.49, 1.26-1.76), and prolonged LOS (OR 1.11, 1.02-1.19; OR 1.60, 95%CI 1.46-1.75).

Conclusion/Discussion: There are numerous patient factors that are predictive of poor postoperative outcomes in young adult patients undergoing colorectal surgery, such as frailty, smoking, immunosuppression, and ASA class. Operative time and type of operation are treatment specific factors that are predictive of postoperative morbidity. Further data exploring optimization of these preoperative variables for this increasingly prevalent patient population are necessary.