Impact of direct transfer to critical care on mortality for patients who undergo emergency colorectal cancer resection: a national population-based cohort study in England.
12 affiliations
- 1Research Department of Primary Care and Population Health, University College London, London, UK.
- 2Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
- 3Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
- 4Research Department of Population, Policy and Practice, University College London, London, UK.
- 5Centre for Surgical Research, University of Bristol, Bristol, UK.
- 6Patient and Public Involvement Representative, Royal College of Surgeons of England, London, UK.
- 7Intensive Care National Audit and Research Centre, London, UK.
- 8Anaesthesia and Peri-operative Medicine, University College London Hospitals NHS Foundation Trust, London, UK.
- 9Anaesthetic Department, South Tees Hospitals NHS Foundation Trust, London, UK.
- 10Division of Surgery, Manchester Royal Infirmary, Manchester, UK.
- 11Department of Colorectal Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
- 12Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
Abstract
Background
It is recommended that patients receiving emergency surgery and with 'high-risk' of morbidity and mortality should be transferred directly from theatre to critical care. Using a national, population-based cohort study, we estimated the effect of direct transfer to critical care on 90-day mortality after emergency colorectal cancer resection, and the variation amongst English NHS hospitals.Methods
Patients who underwent emergency colorectal cancer resection between December 2016 and November 2019 according to Hospital Episodes Statistics, National Bowel Cancer Audit or National Emergency Laparotomy Audit were included. Patients were identified as having a direct transfer to critical care through linkage with the Intensive Care National Audit and Research Centre Case Mix Programme. Multivariable logistic regression and propensity score methods were used to measure the effect of direct transfer to critical care on 90-day mortality.Results
In total, 10,441 patients underwent an emergency colorectal cancer resection. Unadjusted 90-day mortality was higher in the direct transfer to critical care cohort (10.9%) than in patients without direct transfer to critical care (3.7%) (odds ratio [OR]: 3.16, 95% confidence interval [CI]: 2.65-3.77). There was no evidence of an association after risk adjustment (adjusted OR: 1.16, 95% CI: 0.94-1.43) or after propensity score analysis (weighted OR: 0.94, 95% CI: 0.69-1.27). For patients at high risk with a predicted mortality ≥5%, the proportion of patients with a direct transfer to critical care varied widely amongst hospitals (interquartile range 68%-92%; median 83%).Conclusions
Our findings suggest that apparent higher postoperative mortality in patients having direct transfer to critical care can be mostly explained by characteristics of patients, tumours, physiology and surgery. However, the extent to which direct transfer to critical care is used varies widely amongst hospitals. Further work to understand this variation has the potential to improve patient outcomes after emergency colorectal cancer resection.
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BibTeX
@article{blake2026impact,
title = {{Impact of direct transfer to critical care on mortality for patients who undergo emergency colorectal cancer resection: a national population-based cohort study in England.}},
author = {Helen A Blake and Adil Rashid and Leo Watton and Angela Kuryba and Jemma M Boyle and Abigail Vallance and Lindy Berkman and David A Harrison and James Doidge and S Ramani Moonesinghe and Dave Murray and Jim Hill and Nicola S Fearnhead and Jan van der Meulen and Linda D Sharples and Kate Walker},
journal = {BJA open},
year = {2026},
month = oct,
doi = {10.1016/j.bjao.2026.100861},
url = {https://europepmc.org/article/MED/42926795},
note = {CC BY},
}
RIS
TY - JOUR
TI - Impact of direct transfer to critical care on mortality for patients who undergo emergency colorectal cancer resection: a national population-based cohort study in England.
AU - Helen A Blake
AU - Adil Rashid
AU - Leo Watton
AU - Angela Kuryba
AU - Jemma M Boyle
AU - Abigail Vallance
AU - Lindy Berkman
AU - David A Harrison
AU - James Doidge
AU - S Ramani Moonesinghe
AU - Dave Murray
AU - Jim Hill
AU - Nicola S Fearnhead
AU - Jan van der Meulen
AU - Linda D Sharples
AU - Kate Walker
PY - 2026
DA - 2026/10/15
JO - BJA open
DO - 10.1016/j.bjao.2026.100861
UR - https://europepmc.org/article/MED/42926795
AB - Background It is recommended that patients receiving emergency surgery and with 'high-risk' of morbidity and mortality should be transferred directly from theatre to critical care. Using a national, population-based cohort study, we estimated the effect of direct transfer to critical care on 90-day mortality after emergency colorectal cancer resection, and the variation amongst English NHS hospitals.Methods Patients who underwent emergency colorectal cancer resection between December 2016 and November 2019 according to Hospital Episodes Statistics, National Bowel Cancer Audit or National Emergency Laparotomy Audit were included. Patients were identified as having a direct transfer to critical care through linkage with the Intensive Care National Audit and Research Centre Case Mix Programme. Multivariable logistic regression and propensity score methods were used to measure the effect of direct transfer to critical care on 90-day mortality.Results In total, 10,441 patients underwent an emergency colorectal cancer resection. Unadjusted 90-day mortality was higher in the direct transfer to critical care cohort (10.9%) than in patients without direct transfer to critical care (3.7%) (odds ratio [OR]: 3.16, 95% confidence interval [CI]: 2.65-3.77). There was no evidence of an association after risk adjustment (adjusted OR: 1.16, 95% CI: 0.94-1.43) or after propensity score analysis (weighted OR: 0.94, 95% CI: 0.69-1.27). For patients at high risk with a predicted mortality ≥5%, the proportion of patients with a direct transfer to critical care varied widely amongst hospitals (interquartile range 68%-92%; median 83%).Conclusions Our findings suggest that apparent higher postoperative mortality in patients having direct transfer to critical care can be mostly explained by characteristics of patients, tumours, physiology and surgery. However, the extent to which direct transfer to critical care is used varies widely amongst hospitals. Further work to understand this variation has the potential to improve patient outcomes after emergency colorectal cancer resection.
SN - 2772-6096
ER -