Short-term surgical outcomes in patients with early- versus average-onset colon adenocarcinoma in the Military Health System

Background Diagnosis, treatment, and outcomes of colon cancer in the United States differ between patients younger than age 50 (early-onset colon cancer [EOCC]) and those age 50 or older (average-onset [AOCC]) and may be impacted by access to care. Less is known about surgical quality and postoperative outcomes between patients with EOCC and AOCC. This study aimed to compare patients with EOCC and AOCC in surgical aspects and 30-day postoperative complications and readmissions in the Military Health System. Methods The cohort included patients diagnosed with stage I-III colon adenocarcinoma between 2001 and 2014 who received surgery. Poisson regression with robust standard errors estimated the adjusted risk ratios (ARRs) and 95% confidence intervals (CIs) in association with age at diagnosis for the outcomes. Results Among 333 patients with EOCC and 1369 patients with AOCC, there were no statistically significant differences in surgical delay, positive margins, or inadequate lymphadenectomy. Patients with EOCC had statistically higher adjusted 30-day risk of any complication (ARR = 1.31, 95% CI = 1.05 to 1.63), inclusive of general surgical (ARR = 1.64, 95% CI = 1.14 to 2.38) and gastrointestinal (ARR = 1.29, 95% CI = 1.00 to 1.65) complications, relative to patients with AOCC. There was no statistically significant difference in 30-day readmission for patients with EOCC (ARR = 1.30, 95% CI = 0.84 to 202) compared with patients with AOCC. Conclusion In the Military Health System, patients with EOCC had higher adjusted 30-day risk of complications following surgery compared with patients with AOCC. This finding may have implications for care delivery and postoperative management of patients with EOCC to reduce complication burden and achieve optimal outcomes.