title: Predictors of outcome following surgery in colonic perforation: an institution's experience over 6 years.
abstract: BACKGROUND
  Colonic perforation is associated with abysmal outcome. The aims of our study were to review the surgical outcome of patients with perforated colon and to identify factors predicting peri-operative complications.
  
  
  METHODS
  A retrospective review of all patients who underwent surgery for colonic perforation from January 2003 to August 2008 was performed. Patients with iatrogenic or traumatic perforation were excluded. The severity of abdominal sepsis was graded using the Mannheim peritonitis index (MPI).
  
  
  RESULTS
  A total of 129 patients, with median age of 65 years (22-97 years), formed the study group. While 29.5% had severe peritoneal contamination, 56.6% had an American Society of Anesthesiologists (ASA) score ≥3. Sigmoid colon (47.3%) and caecum (24.8%) were the most common sites of perforation. Diverticulitis and malignancy were the diagnoses in 51.9% and 34.9%, respectively. Hartmann's procedure and right hemicolectomy were performed in 43.4% and 34.1% of the patients, respectively. Stoma was created in 59.7%. The in-hospital mortality rate in our series was 15.5%. After multivariate analysis, the independent variables associated with worse peri-operative complications were ASA score ≥3, MPI >26 and creation of stoma. Malignant perforation was associated with higher ASA score and lower haematocrit level compared to diverticular perforation. Stoma was created more frequently in patients with MPI >26 and left-sided perforation, and was associated with worse complications.
  
  
  CONCLUSIONS
  Surgery for colonic perforation is associated with high morbidity and mortality rates. Short-term outcome is determined by ASA score and severity of peritonitis. A lower haematocrit level must alert the possibility of malignancy.
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. kerkan@gmail.com
authors.forename: Ker-Kan
authors.initials: KK
authors.lastname: Tan
authors.forename: Choon-Chiet
authors.initials: CC
authors.lastname: Hong
authors.forename: Junren
authors.initials: J
authors.lastname: Zhang
authors.forename: Jody Zhiyang
authors.initials: JZ
authors.lastname: Liu
authors.forename: Richard
authors.initials: R
authors.lastname: Sim
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D003106:Colon / Q000473:pathology / Q000601:surgery*; D003110:Colonic Neoplasms / Q000150:complications*; D003125:Colostomy / Q000009:adverse effects; D004239:Diverticulitis, Colonic / Q000150:complications*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000209:etiology* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
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