title: Is emergency right hemicolectomy still associated with significant morbidity and mortality rates? An institution's experience of 207 cases over 6 years.
abstract: BACKGROUND
  Emergency right hemicolectomy has been associated with dismal outcome. But, data in Asians is lacking as pathologies that require emergency right hemicolectomy may differ from that in the Western population. The aims of our study were to review our institution's experience with emergency right hemicolectomies and to identify factors that could predict the per-operative outcome.
  
  
  METHODS
  A retrospective review of all patients who underwent emergency right hemicolectomy from August 2003 to April 2008 was performed. Emergency right hemicolectomy was defined as a right colectomy, comprising of an ileo-colic resection, in the emergency setting without the benefit of preoperative bowel preparation. All the complications were graded according to the classification proposed by Clavien and group.
  
  
  RESULTS
  A total of 207 patients, median age 62 years (range, 19-94 years), underwent emergency right hemicolectomy during the study period. Neoplasia and complicated diverticular disease were the most common pathologies in 46.4% and 21.7%, respectively. Intestinal obstruction (44.4%) and perforation (26.6%) were the two main indications for surgical intervention in our series. Twenty (9.7%) patients died, and another 39 patients (18.8%) had severe complications. Eight (3.9%) patients had anastomotic dehiscence, while burst abdomen was seen in ten (4.8%) patients. The two independent factors associated with worse outcome were high ASA score and stoma creation. Factors such as age and site of perforation were not related.
  
  
  CONCLUSIONS
  Emergency right hemicolectomy is associated with a significant morbidity and mortality rate. Patients with higher ASA score and who had stoma created fared worse.
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: Jody Zhiyang
authors.initials: JZ
authors.lastname: Liu
authors.forename: Yuyi
authors.initials: Y
authors.lastname: Yeow
authors.forename: Sivaraj
authors.initials: S
authors.lastname: Gunasekaran
authors.forename: Jane Jye-Yng
authors.initials: JJ
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000401:mortality*; D004630:Emergencies / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000145:classification / Q000209:etiology; D012846:Singapore / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult