title: Ischemic colitis: analysis of risk factors for postoperative mortality.
abstract: BACKGROUND
  Ischemic colitis is a disease with high postoperative mortality when surgery is necessary. The definition of risk factors for perioperative mortality, which is currently lacking in the literature, could be helpful in clinical decision making and in optimizing perioperative treatment.
  
  
  METHODS
  Based on a prospective database, 85 consecutive patients undergoing surgery for ischemic colitis between November 04, 2001 and October, 26, 2004 at the Department of Surgery, University of Heidelberg, were included in this study. The influence of different known factors on perioperative mortality such as age, type of operation, blood loss, comorbidities, hospital course, and complications was tested by univariate and multivariate analysis.
  
  
  RESULTS
  Sixty-seven percent of patients were operated as emergency cases (within 24 h after surgical evaluation). About half of the patients underwent subtotal or total colectomy and 80% had stoma creation. Twenty-two percent of patients developed surgical complications and 47% of patients died in the further postoperative course. Univariate analysis showed underlying cardiovascular diseases, American Society of Anesthesiologists (ASA) status, emergency surgery, total colectomy, elevated intraoperative blood loss and intraoperative allogeneic blood transfusion or transfusion of fresh frozen plasma to be associated with an increased postoperative mortality. Multivariate analysis confirmed ASA status > III, emergency surgery, and blood loss to be independently associated with postoperative mortality in ischemic colitis.
  
  
  CONCLUSIONS
  The mortality of patients requiring surgery for ischemic colitis will remain high as the majority of afflicted patients are patients with significant comorbidities in a reduced general condition. But earlier diagnosis and measures to reduce blood loss may contribute to improving the overall outcome.
authors.affiliation: Department of Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Dalibor
authors.initials: D
authors.lastname: Antolovic
authors.forename: Moritz
authors.initials: M
authors.lastname: Koch
authors.forename: Ulf
authors.initials: U
authors.lastname: Hinz
authors.forename: Dominik
authors.initials: D
authors.lastname: Schöttler
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmidt
authors.forename: Ulrike
authors.initials: U
authors.lastname: Heger
authors.forename: Jan
authors.initials: J
authors.lastname: Schmidt
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality; D002423:Cause of Death; D003082:Colectomy; D017091:Colitis, Ischemic / Q000601:surgery*; D003125:Colostomy; D015897:Comorbidity; D004630:Emergencies; D005260:Female; D005858:Germany; D006801:Humans; D015994:Incidence; D007416:Intestinal Perforation / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors