title: Postoperative morbidity and mortality among Veterans Health Administration patients undergoing surgical resection for large bowel polyps (bowel resection for polyps).
abstract: BACKGROUND
  Large bowel polyps with malignant characteristics or those that are too large to remove colonoscopically may require bowel resection.
  
  
  METHODS
  We performed a retrospective review of 126 Veterans Health Administration patients who underwent elective resections for colonoscopically unresectable colorectal polyps over a 10-year period. We evaluated the association of patient characteristics and operative management on the composite outcome of 30-day postoperative morbidity and mortality.
  
  
  RESULTS
  98% of patients were males. Mean age was 65.1 years. Most patients had comorbidities, including cardiac or vascular disease (47.4%), diabetes mellitus (54%), and tobacco (41%) or alcohol (32.5%) use. The majority (85.7%) of patients were considered to be in American Society of Anesthesiologists (ASA) physical status classifications III and IV. 92% of resections were completed via laparotomy. Thirty-day postoperative morbidity and mortality occurred among 40 (31.7%) patients. Fifty-six patients (44.4%) had operative specimens with malignant features. The only comorbidity statistically associated with 30-day morbidity and mortality was body mass index >30.
  
  
  CONCLUSIONS
  Approximately one third of patients had significant postoperative morbidity or mortality. Clinical pathways chosen to treat colonoscopically unresectable polyps should be tailored to patients' conditions and the characteristics of their colorectal lesions.
authors.affiliation: Department of Surgery, Veterans Health Administration-Tennessee Valley Healthcare System, Vanderbilt University, Nashville Tenn., USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Ikard
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Snyder
authors.forename: Christianne L
authors.initials: CL
authors.lastname: Roumie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D003111:Colonic Polyps / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D019091:Critical Pathways / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000453:epidemiology; D017558:Elective Surgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011230:Precancerous Conditions / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D064424:Tobacco Use / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*