Page 114 - Risk quantification and modification in older patients with colorectal cancer

Chapter 6
Patients and methods
Data and Participants
This study is reported in accordance with the recommendations set forth by The Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) Initiative.22 This study was approved by the medical ethical review board of Southwest Holland, The Netherlands. A waiver for informed consent was granted due to the retrospective of this study.
Five Dutch Hospitals provided data for this study. Patient demographic data, as well as outcome data, were retrieved from the Dutch ColoRectal Audit (DCRA) between January 2014 and December 2017. The DCRA is a national mandatory surgical database contains pre-, peri- and postoperative surgical and outcome data on all operated CRC patients in the Netherlands as part of a national quality improvement project. From the Electronic Hospital Records (EHRs), Geriatric Data were retrieved that were registered as part of standard preoperative care.
Patients who were 70 years or older on the day of surgery were identified from the DCRA. All consecutive patients are prospectively enrolled in this database by qualified staff.23 Eligible for inclusion were patients with elective surgery for stage I-III CRC. Exclusion criteria were synchronous cancer at diagnosis, non-elective or Transanal endoscopic microsurgery (TEMS).
The Enhanced Recovery After Surgery (ERAS) guidelines24 were part of standard care. Other standard care measures and interventions during the study period were the detection of undernutrition and dietary support when needed, post-operative physiotherapy in case of functional dependency (Activities of Daily Living, ADL) and early detection of delirium in high-risk patients.
Outcome
A complication was defined as in-and-out of hospital morbidity (of any kind) within 30-days of surgery. A severe complication was defined as a complication leading to ICU admission (more than two days), a reintervention (surgical or radiological), prolonged hospital stay (more than 14 days), or postoperative mortality. This is consistent with previous publications in which outcome data from the DCRA were analysed.25
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