Diseases of the colon and rectum
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Inferior outcomes in younger patients with colorectal cancer may be associated with multiple factors, including tumor biology, delayed diagnosis, disparities such as access to care, and/or treatment differences. ⋯ In an equal-access system, young age at presentation (<50 years) was associated with advanced stage and higher recurrence of colorectal cancer, but similar survival in comparison with older patients. Although increased adjuvant therapy use in younger patients may partially account for stage-specific increases in survival, the relative decreased chemotherapy use overall requires further evaluation.
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Despite laparoscopy and enhanced recovery pathways, some patients do not attain early discharge. Frailty is generally accepted as a marker of increased risk, complications, and mortality. Frailty may have the potential to identify patient outcomes. ⋯ Patients undergoing elective colorectal surgery with a higher Modified Frailty Index were more likely not to attain early discharge. Despite similar demographics, the Modified Frailty Index could discriminate between patient outcomes, and correlated with longer operating times, length of stay, and readmissions. By using a prospective score to identify patients at risk for not achieving early discharge preoperatively, resources and postoperative support can be better allocated.