Abstract
IntroductionEven after surgery and intensive postoperative management, the mortality rate associated with colorectal perforation is high. Identification of mortality markers using routinely available preoperative parameters is important.MethodsWe enrolled consecutive patients with colorectal perforation who underwent operations from January 2010 to January 2015. We divided them into a mortality and survivor group and compared clinical characteristics between the two groups. Additionally, we compared the mortality rate between different etiologies: malignant versus benign and diverticular versus nondiverticular. We used the χ2 and Mann–Whitney U tests and a logistic regression model to identify factors associated with mortality.ResultsWe enrolled 108 patients, and 52 (48 %) were male. The mean age at surgery was 71 ± 13 years. The postoperative mortality rate was 12 % (13 patients). Multivariate logistic regression analysis showed that a high patient age (odds ratio [OR], 1.09; 95 % confidence interval [CI], 1.020–1.181) and low preoperative systolic blood pressure (OR, 0.98; 95 % CI, 0.953–0.999) were independent risk factors for mortality in patients with colorectal perforation. In the subgroup analysis, there was no significant difference between the malignant and benign group (11.8 % vs. 23.9 %, respectively; p = 0.970), while the diverticular group had a significantly lower mortality rate than the nondiverticular group (2.6 % vs. 17.1 %, respectively; p = 0.027).ConclusionsOlder patients and patients with low preoperative blood pressure had a high risk of mortality associated with colorectal perforation. For such patients, operations and postoperative management should be performed carefully.
Highlights
Even after surgery and intensive postoperative management, the mortality rate associated with colorectal perforation is high
Worldwide Observational (CIAOW) study, a large multicenter observational study that included 1898 patients undergoing surgery or interventional drainage for complicated intra-abdominal infections performed by Sartelli et al [1], indicated that colonic nondiverticular perforation was a source of infection that was significantly correlated with patient mortality
Our study indicates that higher age and a lower preoperative systolic blood pressure are independent risk factors for mortality in patients with colorectal perforation
Summary
Even after surgery and intensive postoperative management, the mortality rate associated with colorectal perforation is high. Colorectal perforation causes widespread dissemination of bacteria throughout the intra-abdominal space and leads to panperitonitis and septic shock. The mortality rate associated with colorectal perforation is considered to be high. Worldwide Observational (CIAOW) study, a large multicenter observational study that included 1898 patients undergoing surgery or interventional drainage for complicated intra-abdominal infections performed by Sartelli et al [1], indicated that colonic nondiverticular perforation was a source of infection that was significantly correlated with patient mortality. Immediate surgical management of colorectal perforation is necessary, and preoperative knowledge of the severity of colorectal perforation and risk factors for mortality is Yamamoto et al World Journal of Emergency Surgery (2015) 10:24 important. Patients with severe peritonitis should undergo preoperative preparations for high-quality postoperative intensive care. Adequate information about the likelihood of mortality should be provided to the patient and his or her family before the operation
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