Days alive and out of hospital at 90 days as a composite outcome measure in patients undergoing elective surgery for colorectal cancer- a nationwide, observational study

OBJECTIVE: The aim of this study was to investigate the validity of DAOH-90 in a contemporary cohort of electively operated patients with colorectal cancer and explore its relationship with postoperative outcomes.

DESIGN: The study was a retrospective, observational cohort study.

SETTINGS: Data on patients operated from April 2014 to April 2019 were collected from the Danish Colorectal Cancer Group database and enriched by information from the Danish National Patient Register. DAOH-90 was analyzed by quantile regression for the 10th, 25th, 50th, 75th, and 90th percentile, using Mann-Whitney U-test, and association between DAOH-90 and 1-and 5-year mortality was analyzed using a Cox regression.

PATIENTS: A total of 16,183 patients with colorectal cancer were included. Median DAOH-90 was 85 (IQR: 82-87). The 90-day mortality was 2.2%.

MAIN OUTCOME MEASURES: The primary outcome was the association between DAOH-90 quantiles and long-term mortality (1 and 5 years).

RESULTS: There was significant association between DAOH-90 in the 25th, 50th and 75th quantile and death between 90 and 365 days (p = 0.0008-< 0.0001), and for death between 1 and 5 years (p = 0.0026-p < 0.0001). Both medical and surgical complications were associated with significantly lower DAOH-90 for all percentiles. The multivariable quantile regression confirmed that notably complications and poor performance status had great impact on DAOH-90.

CONCLUSION: DAOH-90 was associated with several demographic and comorbidity related variables, including severe surgical complications. DAOH-90 was also associated with long-term mortality.