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

Blake, HA; Rashid, A; Watton, L; Kuryba, A; Boyle, JM; Vallance, A; Berkman, L; Harrison, DA; Doidge, J; Moonesinghe, SR; Murray, D; Hill, J; Fearnhead, NS; van der Meulen, J; Sharples, LD; Walker, K

doi:10.1016/j.bjao.2026.100861

Safety, quality & education

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

BJA OpenPublished 15 Oct 2026national, population-based cohort study

Main finding · 90-day mortality (unadjusted)ResultOdds ratio 3.16 95% CI 2.65–3.77

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Authors' conclusion

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.

Study context

Population: Patients who underwent emergency colorectal cancer resection between December 2016 and November 2019 in English NHS hospitals, according to Hospital Episodes Statistics, National Bowel Cancer Audit or National Emergency Laparotomy Auditunderwent an emergency colorectal cancer resection
Participants: 10,441 patients

Exposure: Direct transfer to critical care vs no direct transfer to critical care
Outcome: 90-day mortality (unadjusted)
Follow-up: 90 days

Methodological detailsmultivariable logistic regression, propensity score methods

Multivariable logistic regression
Propensity score methods

Main finding

As reported in the abstract

Odds ratio

3.16

95% CI 2.65–3.77

By group

Direct transfer to critical care10.9%

Without direct transfer to critical care3.7%

Direct transfer to critical care vs without direct transfer to critical care

OR 3.16 (95% CI 2.65–3.77)

Observational data: associations, not effects.

Further findings

Outcome	← Lower odds with direct transfer to critical care ←→ Higher odds with direct transfer to critical care →	Estimate
90-day mortality (risk adjusted) · no evidence of an association	0.512	adjusted OR 1.16 (95% CI 0.94–1.43)
90-day mortality (propensity score analysis) · no evidence of an association	0.512	weighted OR 0.94 (95% CI 0.69–1.27)
	0.512Ratio (log scale)

Proportion of high-risk patients (predicted mortality ≥5%) with direct transfer to critical care, across hospitals

Median: 83%
Interquartile range: 68%-92%

Varied widely amongst hospitals

Original publication

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. BJA Open. Published 15 October 2026. doi:10.1016/j.bjao.2026.100861

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