Outcomes of elective vs. Emergency right colectomy in octogenarians – An important aspect for decision making in older adults

Objectives: To depict and compare short- and long-term outcomes of elective vs. emergency right colectomy of octogenarian patients. Methods: A retrospective cohort study of octogenarians who underwent elective or emergency right colectomy for cancer. Post-operative outcomes as well as long-term survival were compared between the two groups. Results: Overall, 107 patients underwent surgery (21 urgent, 86 elective). Patients at the emergency surgery group were older than at the elective group (median age of 86.9 vs. 83.3 y, respectively, p = 0.004). More patients in the emergency surgery group had dementia (19% vs. 5.8%, p = 0,058), were living in long-term care facilities (19% vs. 2.3% respectively; p = 0.013), were functionally dependent (57.1% vs. 19.0%, p = 0.021) and had advance disease stage (p = 0.001). They had higher rates of postoperative mortality (19% vs. 1.2%, p = 0.009) and complications (71.4% vs. 31.6%, p = 0.002) rates. Mean survival was 31.2 ± 4.6 months in emergency surgery and 60.9 ± 3.3 months in elective surgery (p < 0.001). Surgery timing, stage of disease and functional status were associated with lower survival on multivariate analysis. Conclusion: Short- and long-term outcomes of emergency surgeries in octogenarians operated for right colon cancer were significantly worse as compared to outcomes of elective surgeries. Unsurprisingly and yet, these grim outcomes should be highlighted when discussing treatment options with patients in this age group and their families.