Poster Presentation 2025 National Cancer Survivorship Conference

Examining common reasons and risk factors for emergency presentations post-colorectal cancer surgery: Implications for survivorship care (#136)

Bora Kim 1 , Judith Fethney 2 , Margaret-Ann Tait 2 3 , Claudia Rutherford 2 3 , Kate White 2 3
  1. The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
  2. School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia
  3. Cancer Care Research Unit, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

Introduction

Understanding patterns of emergency department (ED) presentations after receiving cancer treatment can help identify survivorship care gaps. This study examined common reasons and risk factors for early and late ED presentations within the first 4-weeks following surgery for colorectal cancer.

 

Methods

We analysed routinely collected data from three major tertiary hospitals in Sydney. Data for adult patients admitted for a colon or rectum surgery with concurrent colorectal cancer diagnosis between 2015-2020 were included. Prevalence and reasons for within 28-day post-surgical ED presentations were reported descriptively. Poisson regression using sociodemographic and clinical variables explored risk factors for early (≤ 7days, week 1) and late (8-28 days, week 2-4) presentations. Multivariable analysis was conducted with variables with p<0.1 in univariate tests.

 

Results

Analyses included 1653 patients; mean age 67 (range 19-98), male (n=945, 57%), colon cancers (n=1166, 71%). 193 patients (12%) made 237 ED presentations. Most ED presentations (n=89, 38.5%) occurred within the first week following discharge and gradually declined. Predominant reasons were gastrointestinal symptoms/surgical complications (n=100, 42%) and infection/wound issues (n=60, 25%). Volume depletion/electrolyte imbalance (n=26, 11%) occurred consistently throughout weeks 1-4 post-discharge. Risk factors for early ED presentation were: colon cancer compared to rectal or overlapping malignancy, IRR 2.73 (95%CI 1.47-5.04) and diabetes-related pre-discharge complication, IRR 3.54 (95%CI 1.54-8.17). Predictors for late ED presentation were: low anterior resection, IRR 1.55 (95%CI 1.11-2.18), having ostomy, IRR 1.55 (95% CI 1.09-2.22), and length of surgical admission stay IRR 1.01 (95% CI 1.01-1.02).

 

Conclusions

Patients who have experienced diabetes-related complications during surgical admission may benefit from pre-discharge education to emphasise the importance of blood glucose control for post-surgical recovery and wound healing. Those with an ostomy should be educated to highlight the importance of maintaining oral intake and monitoring fluid balance to prevent volume depletion and electrolyte imbalance.