Predictors of mortality following emergency open colectomy for ischemic colitis: a single-center experience

Nassiba Beghdadi,Nicolas Mongardon,Iradj Sobhani,Elisa Reitano,Francesco Brunetti,Pascal Desgranges,Alain Luciani,Florence Canoui-Poitrine,Olivier Langeron,Alexis Laurent,Sébastien Mulé,Nicola De’ Angelis,Frederic Cochennec,Margherita Notarnicola,Aurelien Amiot,Daniele Sommacale

doi:10.1186/s13017-020-00321-4

Abstract

BackgroundIschemic colitis (IC) is a severe emergency in gastrointestinal surgery. The aim of the present study was to identify the predictors of postoperative mortality after emergent open colectomy for IC treatment. Additionally, we compared postoperative outcomes of patients undergoing emergent colectomy due to aortic surgery-related IC (AS-IC group) vs. other IC etiologies (Other-IC group).MethodsWe analyzed records of consecutive patients who underwent emergency open colectomy for IC between 2008 and 2019. Logistic regression analysis was performed to identify clinical and operative parameters associated with postoperative mortality. The AS-IC and Other-IC groups were compared for mortality, morbidity, ICU stay, hospital stay, and survival.ResultsDuring the study period, 94 patients (mean age, 67.4 ± 13.7 years) underwent emergent open colectomy for IC. In the majority of cases, IC involved the entire colon (53.2%) and vasopressor agents were required preoperatively (63.8%) and/or intraoperatively (78.8%). Thirty-four patients underwent surgery due to AS-IC, whereas 60 due to Other-IC causes. In the AS-IC group, 9 patients had undergone endovascular aortic repair and 25 open aortic surgery; 61.8% of patients needed aortic surgery for ruptured abdominal aortic aneurism (AAA). Overall, 66 patients (70.2%) died within 90 days from surgery. The AS-IC and Other-IC groups showed similar operative outcomes and postoperative complication rates. However, the duration of the ICU stay (19 days vs. 11 days; p = 0.003) and of the total hospital stay (22 days vs. 16 days; p = 0.016) was significantly longer for the AS-IC group than for the Other-IC group. The rate of intestinal continuity restoration at 1 year after surgery was higher for the Other-IC group than for the AS-IC group (58.8% vs. 22.2%; p = 0.05). In the multivariate model, preoperative increased lactate levels, a delay between signs/symptoms’ onset and surgery > 12 h, and the occurrence of postoperative acute kidney injury were statistically associated with postoperative mortality. Neither IC etiology (aortic surgery vs. other etiology) nor ruptured AAA was associated with postoperative mortality.ConclusionEmergency open colectomy for IC is associated with high postoperative mortality, which appears to be unrelated to the IC etiology. Preoperative lactate levels, > 12-h delay to surgery, and postoperative acute kidney injury are independent predictors of postoperative mortality.

Highlights

Ischemic colitis (IC) is a severe emergency in gastrointestinal surgery [1], being associated with mortality rates of 50–80% [2, 3]
Emergency open colectomy for IC is associated with high postoperative mortality, which appears to be unrelated to the IC etiology
The study protocol was approved by the Institutional Review Board (IRB: 00011558) and was conducted in conformity to the principles declared to the National Commission for Data Protection and Liberties (CNIL: 2210699) and in accordance with the ethical principles described in the Declaration of Helsinki

Summary

Introduction

Ischemic colitis (IC) is a severe emergency in gastrointestinal surgery [1], being associated with mortality rates of 50–80% [2, 3]. Adverse prognostic factors for IC-related mortality include age > 50 years [5], hemodynamic instability [5], isolated right colon involvement [7, 9], history of hypertension, and chronic kidney diseases [7, 8]. The etiologies of IC are numerous, but they can be divided into two main categories: occlusive and nonocclusive diseases [4] In both cases, IC is the result of blood supply insufficiency to the colon leading to various severities of ischemic lesions, from superficial mucosal lesions to full-thickness transmural necrosis [10]. We compared postoperative outcomes of patients undergoing emergent colectomy due to aortic surgery-related IC (AS-IC group) vs. other IC etiologies (Other-IC group)

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