title: Outcomes and predictors of mortality and stoma formation in surgical management of colonoscopic perforations: a multicenter review.
abstract: OBJECTIVE
  To perform a retrospective review of all patients with colonoscopic perforations managed in hospitals within the Eastern New Territories region of Hong Kong and to determine the predictors of mortality and stoma formation in patients with colonoscopic perforations.
  
  
  METHODS
  Retrospective computer-based review.
  
  
  METHODS
  Multicenter (1 university teaching hospital and 2 district hospitals).
  
  
  METHODS
  We reviewed the outcomes of patients with colonoscopic perforations surgically managed between January 1, 1998, and December 31, 2005. Predictors of mortality and stoma formation were identified with multivariable analysis.
  
  
  METHODS
  Mortality and stoma rates and their predictors.
  
  
  RESULTS
  A total of 37,971 colonoscopies were performed during the study period, and 43 colonoscopic perforations were identified. The overall perforation rate was 0.113% and represented a decreasing trend. There was no significant difference in the perforation rate between gastroenterologists (0.148%) and surgeons (0.091%) (P = .15). Perforations that occurred during diagnostic colonoscopies were significantly larger than those that occurred during therapeutic colonoscopies (P = .04), and the patients presented earlier (P = .02). Surgical intervention was performed in 39 patients. The overall morbidity and mortality rate was 48.7% and 25.6%, respectively. The stoma rate was 38.5%. The predictors of stoma formation include moderate to severe peritoneal contamination and the presence of malignant colonic neoplasms (P = .01 and P = .008, respectively). The predictors of mortality include American Society of Anesthesiologists class 3 or higher and antiplatelet therapy (P = .009 and P = .001, respectively).
  
  
  CONCLUSIONS
  Colonoscopic perforations were in a decreasing trend. Patients with predictors of mortality should not be treated conservatively. Other options of large bowel investigations should be considered in high-risk patients when the potential diagnostic yield is low.
authors.affiliation: Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China. anthonyteoh@surgery.cuhk.edu.hk
authors.forename: Anthony Yuen Bun
authors.initials: AY
authors.lastname: Teoh
authors.forename: Chi Ming
authors.initials: CM
authors.lastname: Poon
authors.forename: Janet Fung Yee
authors.initials: JF
authors.lastname: Lee
authors.forename: Hing Tat
authors.initials: HT
authors.lastname: Leong
authors.forename: Simon Siu Man
authors.initials: SS
authors.lastname: Ng
authors.forename: Joseph Jao Yiu
authors.initials: JJ
authors.lastname: Sung
authors.forename: James Yun Wong
authors.initials: JY
authors.lastname: Lau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000293:injuries* / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D054047:Surgical Stomas / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult