Outcomes and predictors of mortality and stoma formation in surgical management of colonoscopic perforations: a multicenter review.
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.
Teoh
Anthony Yuen Bun
AY
Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China. anthonyteoh@surgery.cuhk.edu.hk
Poon
Chi Ming
CM
Lee
Janet Fung Yee
JF
Leong
Hing Tat
HT
Ng
Simon Siu Man
SS
Sung
Joseph Jao Yiu
JJ
Lau
James Yun Wong
JY
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