TY  - JOUR
A1  - Matthes, Niels
A1  - Diers, Johannes
A1  - Schlegel, Nicolas
A1  - Hankir, Mohammed
A1  - Haubitz, Imme
A1  - Germer, Christoph-Thomas
A1  - Wiegering, Armin
T1  - Validation of MTL30 as a quality indicator for colorectal surgery
JF  - PLoS One
N2  - Background 
Valid indicators are required to measure surgical quality. These ideally should be sensitive and selective while being easy to understand and adjust. We propose here the MTL30 quality indicator which takes into account 30-day mortality, transfer within 30 days, and a length of stay of 30 days as composite markers of an uneventful operative/postoperative course. 

Methods 
Patients documented in the StuDoQ|Colon and StuDoQ|Rectal carcinoma register of the German Society for General and Visceral Surgery (DGAV) were analyzed with regard to the effects of patient and tumor-related risk factors as well as postoperative complications on the MTL30. 

Results 
In univariate analysis, the MTL30 correlated significantly with patient and tumor-related risk factors such as ASA score (p<0.001), age (p<0.001), or UICC stage (p<0.001). There was a high sensitivity for the postoperative occurrence of complications such as re-operations (p<0.001) or subsequent bleeding (p<0.001), as well as a significant correlation with the CDC classification (p<0.001). In multivariate analysis, patient-related risk factors and postoperative complications significantly increased the odds ratio for a positive MTL30. A negative MTL30 showed a high specify for an uneventful operative and postoperative course. 

Conclusion 
The MTL30 is a valid indicator of colorectal surgical quality.
KW  - surgical care
KW  - discharge definition
KW  - definition
KW  - mortality
KW  - pancreatectomy
KW  - complications
KW  - superior
KW  - capture
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-230530
VL  - 15
IS  - 8
ER  - 
TY  - JOUR
A1  - Diers, Johannes
A1  - Baum, Philip
A1  - Lehmann, Kai
A1  - Uttinger, Konstatin
A1  - Baumann, Nikolas
A1  - Pietryga, Sebastian
A1  - Hankir, Mohammed
A1  - Matthes, Niels
A1  - Lock, Johann F.
A1  - Germer, Christoph-Thomas
A1  - Wiegering, Armin
T1  - Disproportionately high failure to rescue rates after resection for colorectal cancer in the geriatric patient population - A nationwide study
JF  - Cancer Medicine
N2  - Background
Colorectal cancer incidence increases with patient age. The aim of this study was to assess, at the nationwide level, in-hospital mortality, and failure to rescue in geriatric patients (≥ 80 years old) with colorectal cancer arising from postoperative complications.

Methods
All patients receiving surgery for colorectal cancer in Germany between 2012 and 2018 were identified in a nationwide database. Association between age and in-hospital mortality following surgery and failure to rescue, defined as death after complication, were determined in univariate and multivariate analyses.

Results
Three lakh twenty-eight thousands two hundred and ninety patients with colorectal cancer were included of whom 77,287 were 80 years or older. With increasing age, a significant relative increase in right hemicolectomy was observed. In general, these patients had more comorbid conditions and higher frailty. In-hospital mortality following colorectal cancer surgery was 4.9% but geriatric patients displayed a significantly higher postoperative in-hospital mortality of 10.6%. The overall postoperative complication rate as well as failure to rescue increased with age. In contrast, surgical site infection (SSI) and anastomotic leakage (AL) did not increase in geriatric patients, whereas the associated mortality increased disproportionately (13.3% for SSI and 29.9% mortality for patients with AI, both p < 0.001). Logistic regression analysis adjusting for confounders showed that geriatric patients had almost five-times higher odds for death after surgery than the baseline age group below 60 (OR 4.86; 95%CI [4.45–5.53], p < 0.001).

Conclusion
Geriatric patients have higher mortality after colorectal cancer surgery. This may be partly due to higher frailty and disproportionately higher rates of failure to rescue arising from postoperative complications.
KW  - colorectal cancer
KW  - geriatric
KW  - octogenerians
KW  - surgery
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-312858
VL  - 11
IS  - 22
ER  -