Population-based information on emergency colorectal surgery and evaluation on effect of operative volume on mortality.
BACKGROUND
Population-based information on emergency surgery for colorectal conditions was limited. The present study was designed to review comprehensively the outcomes of emergency colectomy in Hong Kong population and evaluate the effect of case load on mortality after considering case mixes.


METHODS
All adult patients older than aged 18 years who underwent emergency colectomy in 2003 in all 15 Hong Kong public hospitals were included. Demographics and perioperative variables were reviewed and analyzed. Hospitals were classified into low, middle, or high operative volume groups according to their yearly caseloads, and their performance in terms of mortality were compared by using CR-POSSUM.


RESULTS
A total of 864 patients with a mean age of 67.8 years were included. Bowel obstruction and peritonitis were the two major clinical indications for the surgery. The crude in-hospital mortality rate was 18.9%; individual hospitals varied from 8.7% to 33.3%. With the risk adjusted model, all hospital groups performed within 95% confidence limits of prediction. There was no statistical difference for mortality of hospitals of different case volume.


CONCLUSIONS
A crude in-hospital mortality of 18.9% after emergency colorectal surgery was observed in Hong Kong public hospitals. Higher hospital case load is not significantly associated with better outcomes in emergency colectomy.
Kwan
T L
TL
Central Surgical Audit Unit, Hospital Authority, Kowloon, Hong Kong, China. kwantl@ha.org.hk
Lai
F
F
Lam
C M
CM
Yuen
W C
WC
Wai
A
A
Siu
Y C
YC
Shung
E
E
Law
W L
WL
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003107:Colorectal Surgery / Q000401:mortality*; D004630:Emergencies; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality; D012307:Risk Factors