Predictors of mortality following emergency open colectomy for ischemic colitis: a single-center experience.
Abdominal surgery
Aortic surgery
Emergency surgery
Ischemic colitis
Journal
World journal of emergency surgery : WJES
ISSN: 1749-7922
Titre abrégé: World J Emerg Surg
Pays: England
ID NLM: 101266603
Informations de publication
Date de publication:
29 06 2020
29 06 2020
Historique:
received:
19
05
2020
accepted:
17
06
2020
entrez:
1
7
2020
pubmed:
1
7
2020
medline:
9
3
2021
Statut:
epublish
Résumé
Ischemic 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). We 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. During 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. Emergency 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.
Sections du résumé
BACKGROUND
Ischemic 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).
METHODS
We 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.
RESULTS
During 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.
CONCLUSION
Emergency 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.
Identifiants
pubmed: 32600341
doi: 10.1186/s13017-020-00321-4
pii: 10.1186/s13017-020-00321-4
pmc: PMC7325045
doi:
Substances chimiques
Biomarkers
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
40Références
Clin Colon Rectal Surg. 2012 Dec;25(4):228-35
pubmed: 24294125
Colorectal Dis. 2012 Nov;14(11):e751-63
pubmed: 22776101
J Vasc Surg. 2008 Feb;47(2):258-63; discussion 263
pubmed: 18241745
North Clin Istanb. 2018 Sep;5(3):221-226
pubmed: 30688933
World J Emerg Surg. 2015 Mar 08;10:12
pubmed: 25798186
Eur J Vasc Endovasc Surg. 2018 Jul;56(1):31-39
pubmed: 29636250
Surgery. 2011 Apr;149(4):585-92
pubmed: 21247611
Eur J Vasc Endovasc Surg. 2018 Oct;56(4):507-513
pubmed: 30037737
Dis Colon Rectum. 2010 Sep;53(9):1287-94
pubmed: 20706072
Ann Vasc Surg. 2005 May;19(3):328-34
pubmed: 15818455
PLoS One. 2016 Dec 15;11(12):e0167601
pubmed: 27977704
Ann Vasc Surg. 2018 Feb;47:247-252
pubmed: 28919522
Br J Surg. 2005 Apr;92(4):443-8
pubmed: 15736215
Dis Colon Rectum. 1997 Dec;40(12):1448-54
pubmed: 9407984
J Visc Surg. 2013 Feb;150(1):19-28
pubmed: 23433833
Tech Coloproctol. 2014 Jul;18(7):623-7
pubmed: 24435474
World J Gastroenterol. 2008 Dec 28;14(48):7302-8
pubmed: 19109863
Diagn Interv Imaging. 2018 Mar;99(3):123-134
pubmed: 29433829
Colorectal Dis. 2011 Jul;13(7):744-7
pubmed: 20374265
Am J Gastroenterol. 2007 Oct;102(10):2247-52
pubmed: 17561968
Nouv Presse Med. 1976 Jan 10;5(2):77-9
pubmed: 1264637
Surg Endosc. 2016 Aug;30(8):3321-6
pubmed: 26490770
Am J Surg. 2010 Nov;200(5):646-50
pubmed: 21056146
Gut Liver. 2015 Nov 23;9(6):761-6
pubmed: 26347510
Dis Colon Rectum. 2009 Apr;52(4):640-5
pubmed: 19404068
Clin Radiol. 2015 Mar;70(3):262-9
pubmed: 25522900
J Vasc Surg. 2004 Apr;39(4):792-6
pubmed: 15071443
Int J Colorectal Dis. 2014 Apr;29(4):493-503
pubmed: 24425619
Endosc Int Open. 2017 Nov;5(11):E1119-E1127
pubmed: 29124121
Expert Rev Gastroenterol Hepatol. 2013 Sep;7(7):605-13
pubmed: 24070152
World J Surg. 2020 Mar;44(3):927-938
pubmed: 31646369
Clin Colon Rectal Surg. 2015 Jun;28(2):93-8
pubmed: 26034405
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
Langenbecks Arch Surg. 2008 Jul;393(4):507-12
pubmed: 18286300
J Vasc Surg. 2016 Apr;63(4):866-72
pubmed: 26747680
Kidney Int Suppl. 2008 Apr;(109):S1-99
pubmed: 18382440
Dig Liver Dis. 2014 Jun;46(6):505-11
pubmed: 24656307
World J Surg. 2011 Nov;35(11):2549-54
pubmed: 21882031
J Gastrointest Surg. 2013 Apr;17(4):784-92
pubmed: 23242848
World J Emerg Surg. 2018 Jul 11;13:31
pubmed: 30008799
Am J Gastroenterol. 2015 Jan;110(1):18-44; quiz 45
pubmed: 25559486
Int J Colorectal Dis. 2016 Jul;31(7):1273-81
pubmed: 27251703
Colorectal Dis. 2016 Oct;18(10):949-958
pubmed: 27206727