[Emergency colonic surgery: analysis of risk factors predicting morbidity and mortality].
The aim of the present study was to identify risk factors for morbidity and mortality in patients submitted to emergency colonic surgery. Between 1997 and 2008 157 patients, 106 of whom affected by colon cancer (67.5%) and 51 by benign disease (32.5%), were treated. The risk factors for morbidity and mortality were evaluated by univariate and multivariate analysis considering clinical and demographic data. The overall 30-day morbidity and mortality rates were 19.1% (30 patients) and 12.7% (20 patients), respectively. Among patients affected by cancer the mortality rate was 15% (16 patients) and the morbidity rate 23.6% (25 patients), while among the patients with benign disease the mortality rate was 7.8% (4 patients) and the morbidity rate 9.8% (5 patients). No postoperative surgical complications were noted. The strongest risk factors for early death were postoperative medical complications such as cardiopulmonary, renal, thrombo-embolic and infectious complications. The results of the univariate analysis showed that advanced age, neoplastic disease, advanced stage of cancer and associated medical disease prior to surgery play a role as risk factors for morbidity and mortality. In the multivariate analysis only the presence of associated medical disease proved to be a significant independent predictor of outcome. Emergency surgery for both neoplastic and benign colonic disease is still associated with an increased risk of death. Although restorative colectomy should be regarded as the first choice procedure in the emergency setting, Hartmann's procedure is still widely used in high-risk patients.
Costa
Gianluca
G
Dipartimento di Chirurgia, II Facoltà di Medicina e Chirurgia, Università Roma Sapienza, Azienda Ospedaliera Sant'Andrea, Roma.
Tomassini
Federico
F
Tierno
Simone Maria
SM
Venturini
Luigi
L
Frezza
Barbara
B
Cancrini
Giulio
G
Mero
Alessandro
A
Lepre
Luca
L
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D003108:Colonic Diseases / Q000401:mortality* / Q000601:surgery*; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D004638:Emergency Treatment / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors