Abstract
IntroductionIschemic colitis (IC) is a disease with high postoperative morbidity and mortality. Knowledge of the risk factors for postoperative mortality could be helpful in clinical decision making and in optimizing postoperative treatment.MethodsFrom a prospective database, we conducted a retrospective medical record review of 50 patients who underwent surgery for IC between 2003 and 2011 at our institution. We analyzed the causes and potential risk factors for early mortality after surgery for IC.ResultsThe early postoperative mortality and morbidity rates were 30.0% (15/50) and 54% (27/50), respectively. The two most common causes of death were multi-organ failure (66.7%, 10/15) and fulminant septic shock (20.0%, 3/15). Univariate analysis showed that postoperative mortality was significantly associated with preoperative nephropathy, coronary artery disease, a previous history of cardiovascular surgery, an ASA score ≥ 4, surgical delay ≥ 3 days, preoperative hemodynamic instability, and use of pre- and intraoperative adrenergic vasopressors. In the multivariate analysis, a previous history of cardiovascular surgery (odds ratio [OR], 8.2; 95% confidence interval [CI], 1.2–56.5) and surgical delay ≥ 3 days (OR, 5.7; 95% CI, 1.2–27.9) were identified as independent risk factors for postoperative mortality.ConclusionsBecause surgical delay is an avoidable determinant of early mortality, a high index of suspicion and early surgical intervention can increase survival. A routine postoperative evaluation for IC may be helpful in patients with a previous history of cardiovascular surgery.
Highlights
Ischemic colitis (IC) is a disease with high postoperative morbidity and mortality
Univariate analysis showed that postoperative mortality was significantly associated with preoperative nephropathy (p = 0.029), coronary artery disease (p = 0.023), a previous history of cardiovascular surgery (p = 0.006), an American Society of Anesthesiologists (ASA) score ≥ 4 (p = 0.039), surgical delay ≥ 3 days (p = 0.021), preoperative hemodynamic instability (p = 0.021), and severe hemodynamic instability requiring adrenergic vasopressors (p = 0.043)
A previous history of cardiovascular surgery and a surgical delay ≥ 3 days (OR, 5.7; 95% Confidence interval (CI), 1.2–27.9) were identified as independent risk factors for postoperative mortality (Table 4)
Summary
Ischemic colitis (IC) is a disease with high postoperative morbidity and mortality. Knowledge of the risk factors for postoperative mortality could be helpful in clinical decision making and in optimizing postoperative treatment. Despite improvements in perioperative care, the postoperative mortality rate after surgery for ischemic colitis (IC) remains high, and has been reported to be more than 30% [1,2,3,4]. This excess mortality rate is highest during the immediate postoperative period, patients who survive the initial acute IC event can achieve long-term survival. The aim of this study was to assess the incidence of morbidity and mortality in patients undergoing surgical treatment for IC at our institution. We aimed to assess the causes and predictive factors of early mortality, and to determine whether a delay in surgery was associated with higher postoperative mortality of patient who undergo an operation for IC
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