Predictive factors of in-hospital mortality in colon and rectal surgery.
BACKGROUND
Knowledge of the independent risk factors for mortality in colon and rectal surgery can aid surgeons in surgical decision making and in providing patients with appropriate information about the risks of surgery. This study endeavors to identify the risk factors for mortality that are associated with colon and rectal surgery.


METHODS
Using the Nationwide Inpatient Sample database, we examined the clinical data of patients who underwent colon and rectal resection from 2006 to 2008. Multivariate regression analysis was performed to identify factors predictive of in-hospital mortality.


RESULTS
A total of 975,825 patients underwent colon and rectal resection during this period. Overall, the rate of in-hospital mortality was 4.50% (elective surgery, 1.42% vs emergent surgery, 8.76%; p < 0.01). Mortality was lower after laparoscopic compared with open operation (1.43% vs 4.74%; p < 0.01). Using multivariate regression analysis, significant risk factors for in-hospital mortality were emergent surgery (adjusted odds ratio [AOR] = 3.53), liver disease (AOR = 3.02), age older than 65 years (AOR = 2.92), total colectomy (AOR = 2.88), chronic renal failure (AOR = 2.37), malignant tumor (AOR = 2.0), open operation (AOR = 1.85), peripheral vascular disease (AOR = 1.81), diverticulitis (AOR = 1.77), transverse colectomy (AOR = 1.43), chronic lung disease (AOR = 1.41), ulcerative colitis (AOR = 1.40), left colectomy (AOR = 1.31), alcohol abuse (AOR = 1.21), male sex (AOR = 1.12), nonteaching hospital (AOR = 1.11), and African-American race (AOR = 1.09). There was no association between hypertension, diabetes, congestive heart failure, obesity, smoking, proctectomy, sigmoidectomy, or Crohn disease and in-hospital mortality.


CONCLUSIONS
In patients undergoing colorectal surgery, emergent surgery, liver disease, total colectomy, age older than 65 years, chronic renal failure, and malignant tumor are the major risk factors for in-hospital mortality.
Department of Surgery, University of California, Irvine School of Medicine, Orange, CA 92868, USA.
Hossein
H
Masoomi
Celeste Y
CY
Kang
Anne
A
Chen
Steven
S
Mills
Matthew O
MO
Dolich
Joseph C
JC
Carmichael
Michael J
MJ
Stamos
D000367:Age Factors; D000368:Aged; D003082:Colectomy / Q000379:methods / Q000401:mortality*; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D004239:Diverticulitis, Colonic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods / Q000401:mortality; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications; D010535:Laparoscopy / Q000401:mortality; D008107:Liver Diseases / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States