Patient-based factors for EP with colorectal cancer
| Authors | Study design | Patient group | Comparator(s) | Associated | Not associated | Evidence |
|---|---|---|---|---|---|---|
| [Askari et al] (UK, England; 2013)10 | Observational (retrospective analysis of hospital colorectal cancer database) | 237 emergency surgeries | 1025 elective surgeries | Cancer site—colon (OR=2.76–4.83) | Age; gender; deprivation; ethnicity; comorbidity | M |
| Cleary et al (UK, England; 2007)27 | Case–control | 62 EP patients (median age 75); 44% male | 287 elective patients (median age 73); 52% male 310 age-sex matched controls | Symptoms—abdominal pain (OR=6.2), weight loss (OR=3.4), diarrhoea (OR=2.6) | Symptoms—rectal bleeding | S– |
| [Gould et al] (Australia; 2013)29 | Observational (retrospective analysis of admission episodes) | 30 EP patients (mean age 75) | Symptoms—bowel obstruction (±perforation) | I | ||
| Gunnarsson et al (Sweden; 2011)21 | Case–control (nested) | 97 EP patients (median age 77); 49% male | 488 elective patients (median age 74); 50% male | Age—older (median 77 vs 74 years, p=0.02); cancer site—ascending/sigmoid colon (p=0.04) | Gender; comorbidity (hypertension); marital status; home ownership; residence (urban/rural) | M |
| Gunnarsson et al (Sweden; 2013)12 | Observational (retrospective analysis of cancer registry, labour and tax data) | 2856 EP patients (35% aged >80); 47% male | 9437 elective patients (28% aged >80); 49% male | Age—older (≥80 years p<0.001*); marital status—unmarried (OR=1.24); income—lower (OR=1.22); education—lower (p=0.018*); childlessness (p=0.021*) | Gender | S |
| [Khamizar et al] (Malaysia; 2010)30 | Observational (retrospective analysis of cancer registry data) | 42 emergency surgeries | 123 elective surgeries | Symptoms—abdominal pain, change in bowel habit; cancer site—colon | I | |
| Khattak et al (UK, England; 2006)22 | Cross-sectional | 58 emergency admissions (median age 72); 57% male (of all patients) | 43 elective admissions (median age 72); 57% male (of all patients) | Symptoms—shorter time to presentation (median 11.5 vs 49.5 days, p=0.04) | M | |
| MacDonald et al (UK, Scotland; 2011)13 | Observational (retrospective analysis of cancer audit data) | 395 EP patients (mean age 71); 56% male (of all patients) | 1223 elective patients (mean age 68); 56% male (of all patients) | Age—older (mean 70.6 vs 67.9 years p<0.005) | S | |
| Mitchell et al (Canada; 2007)24 | Cross-sectional | 108 emergency resections (mean age 71); 40% male | 347 elective resections (mean age 67); 56% male | Age—older (mean 70.8 vs 67.0 years, p=0.005); Gender—female (29.7% vs 18.2%, p=0.004); symptoms—obstruction (43% vs 2%), pain (23% vs 8%); BMI—extreme (<25 or >40, p=0.001) | Annual household income; Education level; smoking history; family history; previous CRC screening | S− |
| Oldale et al (UK, England; 2000)25 | Cross-sectional | 100 emergency admissions (50% aged ≥75); 47% male | 357 elective admissions (37% aged ≥75); 59% male | Age—older (≥75 years, 42% vs 34%, p=0.05); marital status—single, divorced, widowed (44% vs 35%, p=0.07) | Gender; deprivation | S |
| Oliphant et al (UK, Scotland; 2013)14 | Observational (retrospective analysis of cancer registry, SMR1 and deaths data) | 945 EP patients | 3351 elective patients | Deprivation—higher (23.5% vs 19.5%, p=0.033) | S | |
| Polednak (USA; 2000)15 | Observational (retrospective analysis of cancer registry and hospital discharge data) | 2183 emergency admissions (56% aged ≥75); 46% male | 8840 all other route patients (39% aged ≥75); 51% male | Age—older (75 to ≥85 years, OR=1.89–3.42); Gender—female (53.8% vs 48.7%, p<0.001*); ethnicity—black (OR=1.76); insurance—self-pay (OR=2.08), Medicaid (OR=2.66) | S | |
| Pollock and Vickers (UK, England; 1998)16 | Observational (retrospective analysis of HES and census data) | 53 742 patients | Deprivation—higher (Q3-Q10 OR=1.27–2.29) | S | ||
| Porta et al (Spain; 1998)26 | Cross-sectional | 161 emergency admissions (median age 67); 63% male | 87 elective admissions (median age 70); 64% male | Symptoms—anorexia, weakness, weight loss (24.8% vs 9.2%, p<0.01); symptoms—no presentation at first symptom (34.2% vs 13.8%, p<0.01) | Age; gender; social class; family history; cancer site | S– |
| Rabeneck et al (Canada; 2006)17 | Observational (retrospective analysis of Institute for Health information and health insurance data) | 7739 OPE patients (64% aged >70); 50% male | 33 617 non-OPE patients (53% aged >70); 54% male | Age—older (10-year increment OR=1.19); gender—female (male, OR=0.93); income—lower (highest income, OR=0.78); comorbidity (score 1 to ≥3, OR=1.80–3.51); primary care use—lower (regular care, OR=0.70); previous investigation—lower (Ix in 5 years, OR=0.69) | S | |
| Raine et al (UK, England; 2010)18 | Observational (retrospective analysis of HES data) | 60 684 EP admissions (aged 50–90+); 51% male | 126 293 non-EP admissions (aged 50–90+); 57% male | Age—older (70 to ≥90years, OR=1.41–5.85); gender—female (OR=1.15); deprivation—higher (OR=0.66, least deprived) | S | |
| Sikka and Ornato (USA; 2012)19 | Observational (retrospective analysis of cancer registry, health insurance and census data) | 2092 EP patients (43% aged >80); 42% male | 6938 non-emergency patients (33% aged >80); 47% male | Age—older (75 to ≥85 years, OR=1.45–1.89); gender—female (OR=1.18); health insurance (OR=1.37); comorbidity (score 1 to 3+, OR=1.89–4.11); primary care use—lower (≥1 visit, OR=0.68); secondary care use—higher (≥1 admit, OR=1.29); ED use—higher (p<0.05) | Annual household income; ethnicity | S |
| [Sivakumaran et al] (Australia; 2013)31 | Observational (retrospective medical records review) | 97 EP patients (median age 76); 56% male (of all patients) | 223 elective patients (median age 69); 56% male (of all patients) | Age—older (median 76 vs 69 years, p<0.001); cancer site—colon (rectal cancer, OR=3.20) | I |
[Abstract only].
*Associated in univariate analysis.
BMI, body mass index; CRC, colorectal cancer; EP, emergency presentation; HES, Hospital Episodes Statistics; I, insufficient; Ix, investigation; M, moderate; S–, strong–; S, strong; SMR, Scottish Morbidity Recording.