Preoperative modifiable risk factors in colorectal surgery: an observational cohort study identifying the possible value of prehabilitation

Figures & data

Figure 1. Percentage of colorectal cancer patients with severe postoperative complications (CCI score ≥20), related to the number of preoperative risk factors [ASA III, body mass index (BMI) < 20/>30, pack years (PY) > 15, alcohol (AH) > 3 units/day, hemoglobin level (Hb) < 7 mmol/l, Short Nutritional Assessment Questionnaire (SNAQ) > 3, neoadjuvant therapy]. Y-bars indicate upper 95% confidence limits. Percentages are displayed within the bars.

Table 1. Baseline characteristics according to severity of complications as indicated by the comprehensive complication index in a consecutive sample of 139 colorectal cancer patients, The Netherlands 2015–2016.

	Total group	None or mildCCI =0 and <20	Severe CCI ≥20
	N = 139	n = 100	n = 39	p Value^b
Age in years	69 (39–91)	68 (39–88)	72 (53–91)	0.086
Male sex	57%	53%	76%	0.146
BMI (kg/m^2)	25.1 (18–44)	26.1 (18–39)	25.6 (19–44)	0.511
BMI <20 or BMI ≥30	22%	27%	10%	0.103
Diabetes mellitus	12%	11%	13%	0.763
ASA grade				0.025
I	22%	26%	13%
II	66%	66%	64%
III	12%	8%	23%
Current smoking	17%	16%	18%	0.781
Ever smoked	56%	54%	62%	0.421
Pack years	7 (0–70)	5 (0–70)	15 (0–60)	0.156
Alcohol use >3 units/day	16%	13%	23%	0.144
Hemoglobin <7 mmol/l	19%	12%	62%	<0.001
SNAQ ≥3	14%	12%	18%	0.359
Corticosteroids (present use, excluding inhalers)	3%	3%	3%	0.890
Neoadjuvant therapy	12%	11%	15%	0.478
Risk factors^a
0	24%	38%	15%	0.127
1	37%	39%	36%	0.045
>1	39%	23%	49%	0.011
Length of hospital stay	7 (5–11)	6 (5–7)	16 (11–25)	<0.001

Medians plus range and number plus column percentages (%) are presented for continuous and categorical variables, respectively. Univariate analysis was performed for all preoperative potential risk factors. ^aRisk factors are body mass index (BMI), ASA grade III, diabetes mellitus (DM), current smoking, number of pack years, alcohol use >3 units/day, hemoglobin below 7 mmol/l, Short Nutritional Assessment Questionnaire (SNAQ) score >3, neoadjuvant chemo or radiotherapy, and oral corticosteroid use; ^bnone or mild versus severe complication group. A p value <0.05 was considered statistically significant.

CCI: Comprehensive complication index.

Table 2. Uni- and multivariate analyses of preoperative risk factors of severe postoperative complications (CCI ≥20) in a consecutive sample of 139 colorectal cancer patients, The Netherlands 2015–2016.

	None or mild vs. severeCCI <20 vs. CCI ≥20	None or mild vs. severeCCI <20 vs. CCI ≥20
	Crude OR (95% CI)^a	Adjusted OR (95% CI)^b
Age (years)	1.0 (0.99–1.1)	–
Male	1.8 (0.8–3.8)	–
BMI (kg/m^2) BMI <20 or BMI ≥30	0.3 (0.1–0.95)	0.3 (0.1–1.1)
Diabetes mellitus	1.2 (0.4–3.7)	–
ASA grade (compared to ASA I)
II	2.0 (0.7–5.7)	1.7 (0.6–5.0)
III	5.8 (1.5–22.6)	4.4 (1.04–18.6)
Current smoking	1.1 (0.4–3.1)	–
Pack years >15	2.0 (0.9–4.1)	–
Alcohol use >3 units/day	2.0 (0.8–5.2)	–
Hemoglobin <7 mmol/l	4.6 (1.9–11.1)	3.3 (1.3–8.2)
SNAQ ≥3	1.6 (0.6–4.4)	–
Corticosteroids (present use, excluding inhalers)	0.9 (0.1–8.4)	–
Neoadjuvant therapy	1.5 (0.5–4.3)	–
Number of risk factors (compared to 0)^c
1	2.3 (0.8–6.5)	–
>1	5.2 (1.8–15)	–

^aCalculated by using univariate logistic regression analysis; ^bmultiple logistic regression including all statistical significant variables from the univariate analysis; ^cwe did not include this variable into the multivariate analysis because it is constructed out of these variables.

BMI: body mass index; CCI: comprehensive complication index; SNAQ: Short Nutritional Assessment Questionnaire.