title: Colectomy in intensive care patients: operative findings and outcomes.
abstract: BACKGROUND
  With a critical illness, intestinal complications are associated with high morbidity and mortality.
  
  
  METHODS
  Operative findings and outcomes of 77 intensive care unit (ICU) patients treated with colectomy are described.
  
  
  RESULTS
  Three conditions led to colectomy: sepsis (S group; n = 31), fulminant Clostridium difficile colitis (Cl group; n = 25), and cardiovascular surgery (CV group; n = 21). The median Acute Physiology and Chronic Health score was >25 in all groups. Thickening and distension of the colon was more frequent in the Cl group (p = 0.001), and ischemia was more frequent in the S and CV groups (p < 0.001). Widespread necrosis was more frequent in the CV patients (p = 0.001). The kappa value for ischemic operative findings and histologic necrosis was 0.64 (95 % confidence interval 0.49-0.79). Hospital mortality was 35 % without multiple organ failure (MOF) (n = 31) and 74 % with MOF (n = 46) (p < 0.001). Overall, 38 % were alive at the 1-year follow-up.
  
  
  CONCLUSIONS
  Although colectomy in ICU patients is associated with high hospital mortality, patients who survive beyond their hospital stay have a good 1-year outcome.
authors.affiliation: Department of Anaesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, P.O. Box 21, 90029 Oulu, Finland. seija.sipola@ppshp.fi
authors.forename: Seija
authors.initials: S
authors.lastname: Sipola
authors.forename: Hannu
authors.initials: H
authors.lastname: Syrjälä
authors.forename: Vesa
authors.initials: V
authors.lastname: Koivukangas
authors.forename: Jouko J
authors.initials: JJ
authors.lastname: Laurila
authors.forename: Tuomo
authors.initials: T
authors.lastname: Karttunen
authors.forename: Pasi
authors.initials: P
authors.lastname: Ohtonen
authors.forename: Juha
authors.initials: J
authors.lastname: Saarnio
authors.forename: Tero I
authors.initials: TI
authors.lastname: Ala-Kokko
mesh_terms: D000368:Aged; D013504:Cardiovascular Surgical Procedures; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000150:complications* / Q000401:mortality; D003082:Colectomy / Q000401:mortality; D003092:Colitis / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017091:Colitis, Ischemic / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery; D003422:Critical Care; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications* / Q000401:mortality; D016896:Treatment Outcome