title: A review of factors that affect mortality following colectomy.
abstract: BACKGROUND
  The tightening focus on optimizing surgical outcomes has pushed tracking perioperative mortality to the forefront of interest. The goal of this study is to analyze factors affecting mortality after colorectal resection at a single tertiary care center.
  
  
  METHODS
  Data were collected from a prospective database for all patients undergoing a colorectal resection at our institution over a 12-y period. Data points included patient demographics, comorbidities, operative details, clinical presentation, postoperative complications, and mortality.
  
  
  RESULTS
  A total of 1245 patients were evaluated with 41 deaths (3.3%). Our population was 51% male with an average age of 60.1 ± 15.2 y, mean BMI of 27.5 ± 6.4 kg/m(2), average ASA score of 2.6 ± 0.9, and average of 2.2 ± 1.9 comorbidities. Preoperative factors associated with increased mortality included age, high ASA score, emergent surgery, and the presence of bowel perforation or obstruction (P < 0.05). Intra- and postoperative factors including the transfusion of blood products, length of resection, subtotal colectomy, open versus laparoscopic procedures, the need for reoperation, diagnosis and postoperative complications negatively impact survival (P < 0.05). Stepwise logistic regression demonstrated that high ASA score, emergent procedure, subtotal colectomy, age, obstruction, and open resection as the independent predictors of mortality in a stepwise logistic regression model (P < 0.10).
  
  
  CONCLUSIONS
  Preoperative ASA, emergent procedure, age, open procedure, subtotal colectomy, and obstruction were the independent predictors of mortality in our review. Preoperative optimization and counseling of elderly patients with a high ASA score and/or those requiring an emergency operation should be utilized by surgeons in an effort to improve surgical mortality and patient education.
authors.affiliation: Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Klima
authors.forename: Rita A
authors.initials: RA
authors.lastname: Brintzenhoff
authors.forename: Neal
authors.initials: N
authors.lastname: Agee
authors.forename: Amanda
authors.initials: A
authors.lastname: Walters
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
authors.forename: Gamal
authors.initials: G
authors.lastname: Mostafa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000601:surgery; D003082:Colectomy / Q000401:mortality*; D015179:Colorectal Neoplasms / Q000601:surgery; D015897:Comorbidity; D043963:Diverticulosis, Colonic / Q000601:surgery; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult