In-hospital outcomes of colorectal cancer surgery among patients at Mulago National Referral Hospital: a retrospective cohort study

Abstract

Introduction: Colorectal cancer refers to the development of cancer from the colon or rectum. CRC is curable by surgery in the early stage while advanced or metastatic disease is not curable and treatment is mainly palliative. The probability of morbidity and mortality after colorectal cancer surgery depends on stage of the disease and expertise of the surgeon among other risk factors. The likelihood of complications after CRC surgery is dependent on the patient’s performance scale including co-morbidity, age, nutrition status and quality of postoperative care. Objective: The aim of this study was to determine the in-hospital outcomes of colorectal cancer surgery among patients at Mulago national referral hospital. Methods: This was a retrospective cohort study conducted from January 2020-February 2020.Study participants included CRC patients who had emergency and elective CRC surgery at Mulago national referral hospital between June 2017 and June 2019. Patient’s charts of 133 participants were used to extract demographics, clinical presentation, disease related features, interventions and follow up information. This data was cleaned and exported to STATA version 13 for analysis. Descriptive data was summarized in form of means and SD for normally distributed data, median and inter-quartile range for skewed data. Mortality rate, morbidity rate were determined then multivariate analysis was used to identify the risk factors for morbidity. Results: The in-hospital overall postoperative complication rate after colorectal cancer surgery at Mulago national referral hospital was 38.4% whereas the overall in-hospital mortality rate was 3.8%. Emergency CRC surgery had a postoperative complication rate of 46.9% and mortality rate of 3.1% whereas elective surgery had a complication rate of 35.6% and a mortality rate of 4.0%. Patients who underwent emergency colorectal cancer surgery had a 32% increased risk of developing postoperative complications (HR=1.32, 95% CI=0.76-2.29, P-value=0.323), patients that had neo-adjuvant chemotherapy prior to elective surgery were at 41% increased risk of developing postoperative complications (HR=1.41, 95% CI=1.10-1.81, P-value=0.006). Conclusions: In- hospital postoperative complication and mortality rates were higher than what is reported in other studies but were comparable. Emergency CRC surgery and neo-adjuvant chemotherapy were identified risk factors for development of postoperative complications. Recommendations: There is a need to develop institutional standard protocols for colorectal cancer patients undergoing both emergency and elective CRC surgery in order to reduce the postoperative complication and mortality rates at Mulago national referral hospital.