Demographic Factors of Colorectal Cancer Patients with Paralytic Ileus Among Adults in the United States: A Retrospective Study for Mortality Trends

Abstract

Background: Paralytic ileus is a serious postoperative complication among individuals with colorectal cancer (CRC). Although mortality trends for CRC and paralytic ileus have been described separately, long-term national patterns involving both conditions have not been examined. Methods: We analyzed U.S. mortality data for adults aged ≥45 years from 1999–2023 using CDC WONDER Multiple Cause-of-Death records. CRC was identified using ICD-10 codes C18–C20, and paralytic ileus using K56.0 and K56.7. Age-adjusted mortality rates (AAMRs) were calculated and standardized to the 2000 U.S. population. Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC). Subgroup analyses were descriptive; formal between-group slope comparisons were not performed. Results: A total of 31,363 deaths involved both CRC and paralytic ileus. The national AAMR declined from 1.48 per 100,000 in 1999 to 1.00 in 2023 (AAPC –1.50%; 95% CI –1.73 to –1.28). A significant decline occurred through 2012 (APC =– 3.27%), followed by a nonsignificant upward trend thereafter (APC = 0.63%; p = 0.057). Declines varied by sex, age group, race/ethnicity, and region, with the largest reductions among adults ≥65 years and in the Northeast. Most deaths occurred in inpatient settings (56%). Conclusion: Mortality involving CRC and paralytic ileus declined substantially through 2012, then plateaued. Rising mortality among adults aged 45–64 years and persistent racial and geographic disparities highlight opportunities for improved perioperative quality initiatives, ERAS implementation, and opioid-sparing strategies.