[Objective assessment of the level of comorbidity in geriatric patients with bowel cancer: relationship between the surgical results and survival]. / Evaluación objetiva del grado de comorbilidad en pacientes geriátricos con neoplasia de colon: relación con los resultados quirúrgicos y la supervivencia.

OBJECTIVES: Bowel cancer is increasing in prevalence in geriatrics (older than 65 years). The influence of comorbidities on the post-surgical results of bowel cancer is not well known. Our aim was to assess the comorbidities using the Charlson index in a geriatric population subjected to bowel cancer surgery, and analyse their influence on the postoperative results and the mortality rate. MATERIAL AND METHODS: The study included 115 patients (over 65 years-old and with 5 years follow-up) subjected to bowel cancer surgery in the Vic General Hospital (Barcelona) between the years 2003 and 2005. Three comorbidity groups were established using the Charlson index: absent (0 points), low (1-2 points), and high (≥ 3 points). The postoperative medical and surgical complications, as well as mortality, were determined in each of the groups. RESULTS: The relative risk of a medical complication adjusted for age and stage was 2.7 (95% CI; 1.07-7) and 4.3 (95% CI; 1.3-14) times higher in the low and high comorbidity groups, respectively. There were no differences in post-surgical complications between the comorbidity groups. The length of hospital stay was higher in the in the high comorbidity group compared to the group with no comorbidity (17 days compared to 26 days, P=.02). The relative risk of mortality adjusted for age and stage was 1.7 (95% CI; 1.04-3) and 2.5 (95% CI; 1.3-4.6) in the low and high comorbidity groups, respectively. CONCLUSION: The presence of any level of comorbidity measured by the Charlson index is an independent predictive factor of medical complications and of an increase in overall mortality in geriatric patients subjected to bowel cancer surgery.

Prospective, randomised study on antibiotic prophylaxis in colorectal surgery. Is it really necessary to use oral antibiotics?

BACKGROUND AND AIMS: The use of prophylactic antibiotics in addition to mechanical cleansing is the current standard of care prior to colonic surgery. The question of whether the antibiotics should be administered intravenously or orally, or by both routes, remains controversial. Our aim was to compare three methods of prophylactic antibiotic administration in elective colorectal surgery. METHODS: Three hundred consecutive elective colorectal resections were studied. All patients had preoperative mechanical colon cleansing with oral sodium phosphate and intravenous antibiotic prophylaxis with cefoxitin (one dose before skin incision and two postoperative doses). Patients were randomised to one of the following three groups: group A: three doses of oral antibiotic (neomycin and metronidazole) at the time of mechanical colon cleansing; group B: one dose of oral antibiotic; group C: no oral antibiotics. All patients were followed during their hospital stay and at 7, 14 and 30 days post-surgery. RESULTS: Vomiting occurred in 31%, 11% and 9% of the studied patients (groups A, B and C, respectively) (p<0.001). Nausea was present in 44%, 18% and 13% of patients (p<0.001). Abdominal pain was recorded in 13%, 10% and 4% of patients (p: 0.077). Wound infection was present in 7%, 8% and 6% and suture dehiscence occurred in 2%, 2% and 3% of the patients in the three groups (no differences among them). Neither were differences found among the three groups in terms of urinary infections, pneumonia, postoperative ileus or intra-abdominal abscess. CONCLUSION: The addition of three doses of oral antibiotics to intravenous antibiotic prophylaxis is associated with lower patient tolerance in terms of increased nausea, vomiting and abdominal pain, and has shown no advantages in the prevention of postoperative septic complications. Therefore, we recommend that oral antibiotics should not be used prior to colorectal surgery.