by Buchs NC, Gervaz P, Bucher P, Huber O, Mentha G, Morel P.
The aim of this study was to assess the risk factors associated with mortality and morbidity following colorectal surgery.
All data regarding patients who underwent colonic resection in our institution between November 2002 and February 2006 were prospectively entered into a computerised database.
Over a 40-month period 1,016 colonic resections were performed (43 ileocecal; 225 right; 11 transverse; 98 left; 287 sigmoid; 52 subtotal; 108 low anterior; 29 abdominoperineal resections; 103 Hartmann; 46 reversal of Hartmann; and 14 proctocolectomy). The most common indications for surgery were: adenocarcinoma (44%); diverticulosis (19%); complicated diverticulitis (12%); adenoma (4%); and inflammatory bowel disease (4%). There were 719 (71%) elective and 297 (29%) emergency procedures. Overall mortality and morbidity rates were 5.4% and 20.7% respectively. The anastomotic leak rate was 3.8% (31 leaks out of 809 anastomoses). In univariate analysis, patients who underwent elective surgery had lower mortality (0.7% vs. 17%, p <0.001) and morbidity rates (17% vs. 30%, p <0.001), as well as a shorter hospital stay (12.4 days vs. 19.9 days, p <0.001). In multivariate analysis ASA score >3 and emergency surgery were both associated with increased mortality (p <0.001) and morbidity (p <0.001) following colonic resection.
Elective colectomies are standard procedures carrying below 1% mortality; by contrast, emergency colonic resections remain surgical challenges in compromised and/or elderly patients and are associated with high complication rates.
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in Swiss Medical Weekly 2007, May 5;137 (17-18): 259-64