title: Surgery for ischemic colitis: outcome and risk factors for in-hospital mortality.
abstract: OBJECTIVE
  Surgery for ischemic colitis is associated with high perioperative morbidity and mortality, but the risk factors for mortality and major surgical complications are unclear.
  
  
  METHODS
  In this retrospective single institution cohort study of all patients undergoing colorectal surgery for histologically proven ischemic colitis between 2004 and 2010, we evaluated surgical outcomes and risk factors for in-hospital mortality and major surgical complications.
  
  
  RESULTS
  For the 100 patients included in the study, in-hospital mortality was 54 %; major surgical complications, defined as anastomotic leakage or rectal stump and stoma complications, occurred in 16 %. In the multivariable analysis, hospital death was more likely in patients with right-sided (odds ratio [OR] 3.8; 95 % confidence interval [CI] 1.2, 12; P = 0.022) or pan-colonic ischemia (OR 11; 95 % CI 2.8, 39; P < 0.001), both relative to left-sided ischemia. Decreased preoperative pH level (OR 2.5 per 0.1 decrease; 95 % CI 1.5, 4.1; P < 0.001) and prior cardiac or aortic surgery (OR 2.4; 95 % CI 0.82, 6.8; P = 0.109) were further important risk factors for in-hospital mortality. Major postoperative surgical complications were more likely in patients with ischemic alterations at the resection margin of the histological specimen (OR 3.7; 95 % CI 1.2, 11; P = 0.022).
  
  
  CONCLUSIONS
  Colonic resection for ischemic colitis is associated with high in-hospital mortality, especially in patients with right-sided or pan-colonic ischemia. In patients developing acidosis, early laparotomy is essential. Since resection margins' affection seems to be underestimated upon surgery, resections should be performed wide enough within healthy tissue.
authors.affiliation: Department of Surgery, University Hospital Basel, Basel, Switzerland, jgenstorfer@gmx.de.
authors.forename: Jörg
authors.initials: J
authors.lastname: Genstorfer
authors.forename: Juliane
authors.initials: J
authors.lastname: Schäfer
authors.forename: Christoph
authors.initials: C
authors.lastname: Kettelhack
authors.forename: Daniel
authors.initials: D
authors.lastname: Oertli
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosenthal
mesh_terms: D000368:Aged; D017091:Colitis, Ischemic / Q000473:pathology / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors