Ischemic colitis: risk factors for eventual surgery.
BACKGROUND
Ischemic colitis is a common disorder often without clear indications for surgical management. The aim of this study was to identify risk factors that predict the need for surgery.


METHODS
Patients were identified retrospectively based on International Classification of Disease codes and admission over an 8-year period.


RESULTS
A total of 253 patients presented with ischemic colitis. A total of 205 patients were managed nonsurgically, 12 underwent immediate surgery (within 12 hours of presentation), and 36 had delayed surgery. On univariate analysis, risk factors that predicted delayed surgery were peripheral vascular disease, atrial fibrillation, hypotension, tachycardia, absence of bleeding per rectum, free intraperitoneal fluid on computed tomography scan, intensive care unit admission, vasopressors, mechanical ventilation, and increased lactate level on admission. Intraperitoneal fluid on computed tomography scan and absence of bleeding per rectum were predictive of surgical intervention on multivariate analysis.


CONCLUSIONS
In patients with ischemic colitis, several risk factors were associated with the need for subsequent surgery during the same admission. These factors could be used to select patients for immediate surgery before worsening of their clinical condition.
Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA.
Flavio
F
Paterno
Edward A
EA
McGillicuddy
Kevin M
KM
Schuster
Walter E
WE
Longo
D000368:Aged; D017091:Colitis, Ischemic / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D003237:Connecticut / Q000453:epidemiology; D003657:Decision Making; D013505:Digestive System Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome