• Peter-Martin Krarup, Andreas Nordholm-Carstensen, Lars Nannestad Jorgensen, and Henrik Harling.
• 1 Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark 2 Danish Colorectal Cancer Group, Copenhagen, Denmark.
• Dis. Colon Rectum. 2015 Jul 1;58(7):668-76.

BackgroundComorbidity has a negative influence on the long-term prognosis in patients with colorectal cancer, whereas its impact on the postoperative course is less clear.ObjectivesThe aim of this study was to investigate the influence of comorbidity on anastomotic leak and short-term outcomes after resection for colonic cancer.DesignThis is a retrospective nationwide cohort studySetting: Data were obtained from the Danish Colorectal Cancer Group and the National Patient Registry.PatientsPatients with colonic cancer undergoing elective resection between 2001 and 2008 were selected.Main Outcome MeasuresThe primary outcome was the ability of comorbidity to predict anastomotic leak. Secondary outcomes were 30-day mortality and length of stay. Comorbidity was assessed by the Charlson Comorbidity Index. Multivariable logistic regression and receiver operating characteristics curves were used to adjust for confounding.ResultsThe rate of anastomotic leak was 535/8597 (6.2%). The mean (95% CI) Charlson score was 0.83 (0.72-0.94) and 0.63 (0.61-0.66) for patients with and without anastomotic leak, p < 0.001. The Charlson score, as assessed in the multivariable analysis (adjusted OR, 1.07; 95% CI, 0.99-1.15; p = 0.077) and by receiver operating characteristics curves (area under the curve = 0.548), failed to predict anastomotic leak. Thirty-day mortality was 425/8587 (4.9%). In patients with anastomotic leakage, a Charlson score of ≥ 2 was associated with increased mortality in comparison with a Charlson score of <2 (adjusted HR, 1.58; 95% CI, 1.00-2.51; p = 0.047). Mean length of stay was 8.7 days (95% CI, 8.4-9.2 days) for patients without an anastomotic leak in comparison with 23.3 days (95% CI, 21.5-25.1 days) for patients with anastomotic leak and 25.5 days (95% CI, 21.7-29.3 days) in patients with anastomotic leak and a Charlson score of >2, p < 0.001.LimitationsThis study is limited by the accuracy of the coding used to generate the Charlson Comorbidity Index and the retrospective study design.ConclusionComorbidity failed to predict anastomotic leak, but it was associated with an inferior short-term outcome in patients with this surgical complication.

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