Colorectal Carcinoma in the Frail Surgical Patient. Implementation of a Work Area Focused on the Complex Surgical Patient Improves Postoperative Outcome

Abstract Introduction Advanced age and comorbidity impact on post-operative morbi-mortality in the frail surgical patient. The aim of this study is to assess the impact of a comprehensive, multidisciplinary and individualized care delivered to the frail patient by implementation of a Work Area focused on the Complex Surgical Patient (CSPA). Methods Retrospective study with prospective data collection. Ninety one consecutive patients, classified as frail (ASA III or IV, Barthel 3) underwent curative radical surgery for colorectal carcinoma between 2013 and 2015. Group I: 35 patients optimized by the CSPA during 2015. Group II: 56 No-CSPA patients, treated prior to CSPA implementation, during 2014–2015. Group homogeneity, complication rate, length of stay, reoperations, readmissions, costs and overall mortality were analyzed and adjusted by Diagnosis-Related Group (DRG). Results There were no statistically significant differences in term of age, gender, ASA classification, body mass index, tumor staging and type of surgical intervention between the two groups. Major complications (Clavien-Dindo III–IV) (12.5% vs 28.5%, P =.04), hospital stay (12.6±6 days vs 15.2±6 days, P =.041), readmissions (12.5% vs 28.3%, P P =.008) were statistically inferior in Group CSPA. There were no differences in reoperations (6.2% vs 5.3%) or mortality (6.2% vs 7.1%). 96.9% of patients of Group I manifested having received a satisfactory attention and quality of life. Conclusions Implementation of a CSPA, delivering surgical care to frail colorectal cancer patients, involves a reduction of complications, length of stay and readmissions, and is a cost-effective arrangement.