Predictive factors associated with adverse events in patients with toxic colitis: an analysis of the National Surgical Quality Improvement Project

Abstract

BackgroundToxic colitis (TC) is a potentially lethal complication of inflammatory bowel disease and infectious colitis. MethodsThe National Surgical Quality Improvement Project dataset was queried to identify emergent colectomy for a primary diagnosis of TC using International Classification of Diseases, Ninth Revision codes. The study endpoints were 30-day mortality and 30-day morbidity. We performed multivariate logistic regression analyses to study factors associated with 30-day mortality. ResultsOf the 189 TC patients, mortality for colectomy was 26.5%, 42.3% experienced pulmonary complications, 20.6% experienced sepsis complications, 17.5% experienced cardiovascular complications, 12.7% experienced renal complications, and 14.8% experienced wound complications. On multivariate analysis, independent factors associated with mortality were age 70 to 80 years (odds ratio [OR] 3.5), age greater than 80 (OR 22.2), female sex (OR 4.1), uremia blood urea nitrogen greater than 40 (OR 4.1), coagulopathy international normalized ratio greater than 2 (OR 7.7), preoperative respiratory failure (OR 2.73), and preoperative steroid use (OR 3.9). ConclusionsPatients with TC are very ill. Poor outcome is associated with older age, female sex, preoperative azotemia, preoperative respiratory failure, and chronic steroid use. These factors will help acute care surgeons in preoperative risk assessment and could be an important addition to decision-making strategies.