title: Changes in the surgical approach to colonic emergencies during a 15-year period.
abstract: OBJECTIVE
  The present study aims to determine the morbidity and mortality of emergency colonic surgery and the factors associated with adverse outcome, and to evaluate any change in incidence of the different types of pathological conditions and in the surgical approach over the last 15 years.
  
  
  METHODS
  A total of 319 patients who underwent emergency colonic surgery between January 1997 and December 2011 were retrospectively analyzed. Patients were divided into two groups according to the date of surgery, namely group 1, between 1997 and 2006, and group 2, between 2006 and 2011. The differences in terms of postoperative outcomes between the groups were analyzed.
  
  
  RESULTS
  Overall postoperative morbidity and mortality rates were 25.3 and 17.2%, respectively; no differences were found between the groups. Group 2 showed a significantly increased rate of primary resection and anastomosis (p < 0.001), as well as an increase in laparoscopic approach compared with group 1 (p < 0.001).
  
  
  CONCLUSIONS
  Emergency colon surgery is today primarily performed for benign diseases, of these the most common is diverticular disease followed by ischemic colitis. Age, comorbidities, and ischemic colon disease are predictors of adverse outcomes, while the surgical procedure per se is not.
authors.affiliation: Department of General Surgery, Surgical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology, University of Rome 'La Sapienza', St. Andrea Hospital, Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Costa
authors.forename: Marco
authors.initials: M
authors.lastname: La Torre
authors.forename: Brabara
authors.initials: B
authors.lastname: Frezza
authors.forename: Pietro
authors.initials: P
authors.lastname: Fransvea
authors.forename: Federico
authors.initials: F
authors.lastname: Tomassini
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ziparo
authors.forename: Genoveffa
authors.initials: G
authors.lastname: Balducci
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003108:Colonic Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D004638:Emergency Treatment / Q000379:methods / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061214:Patient Safety; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome