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The Association Between Revised Cardiac Risk Index and Postoperative Mortality Following Elective Colon Cancer Surgery: A Retrospective Nationwide Cohort Study
Örebro universitet, Institutionen för medicinska vetenskaper. Sweden Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Örebro universitet, Institutionen för medicinska vetenskaper. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.ORCID-id: 0000-0003-3583-3443
Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.ORCID-id: 0000-0003-1043-9693
Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. (Clinical Epidemiology and Biostatistics)ORCID-id: 0000-0002-3552-9153
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2021 (Engelska)Ingår i: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 111, nr 1, artikel-id 14574969211037588Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

INTRODUCTION: Despite improvements in the perioperative care during the last decades for oncologic colon resection, there is still a substantial risk for postoperative complications and mortality. Opportunities exist for improvement in preoperative risk stratification in this patient population. We hypothesize that the Revised Cardiac Risk Index, a user-friendly tool, could better identify patients with high postoperative mortality risks.

METHODS: A retrospective analysis of operated patients between the years 2007 and 2017 was undertaken, using the prospectively recorded Swedish Colorectal Cancer Registry, which has a 99.5% national coverage for all cases of colon cancer. Patients were cross-referenced with the Swedish National Board of Health and Welfare dataset, a government registry of mortality and comorbidity data. Revised Cardiac Risk Index (RCRI) scores were calculated for each patient and stratified into four groups (RCRI 1, 2, 3, ⩾ 4). A Poisson regression model with robust standard errors of variance was employed to correlate the 90-day postoperative survival with each level of the Revised Cardiac Risk Index.

RESULTS: A total of 24,198 patients met the study inclusion criteria. 90-day postoperative mortality increased from 2.4% in patients with RCRI 1 to 10.1% in patients with RCRI ⩾ 4 (p < 0.001). Adjusted 90-day postoperative mortality increased linearly with an increasing RCRI, where an RCRI of 2, 3, and ≥ 4 respectively led to a 46%, 80%, and 167% increased risk of mortality compared to RCRI 1 (p < 0.001).

CONCLUSIONS: A strong association between an increasing Revised Cardiac Risk Index score and increased 90-day postoperative mortality risk was detected. The Revised Cardiac Risk Index may facilitate risk stratification of patients undergoing elective colon cancer surgery.

Ort, förlag, år, upplaga, sidor
Sage Publications, 2021. Vol. 111, nr 1, artikel-id 14574969211037588
Nyckelord [en]
Colon cancer, Revised Cardiac Risk Index, mortality, risk stratification, surgery
Nationell ämneskategori
Kirurgi
Identifikatorer
URN: urn:nbn:se:oru:diva-94802DOI: 10.1177/14574969211037588ISI: 000705308000001PubMedID: 34605315Scopus ID: 2-s2.0-85116316903OAI: oai:DiVA.org:oru-94802DiVA, id: diva2:1600435
Tillgänglig från: 2021-10-05 Skapad: 2021-10-05 Senast uppdaterad: 2024-03-06Bibliografiskt granskad

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Ahl, RebeckaForssten, Maximilian PeterPourlotfi, ArvidCao, YangBass, Gary AlanMatthiessen, PeterMohseni, Shahin
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Institutionen för medicinska vetenskaperRegion Örebro län
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Scandinavian Journal of Surgery
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