title: Surgical outcomes and prognostic factors of emergency surgery for colonic perforation: would fecal contamination increase morbidity and mortality?
abstract: OBJECTIVE
  Complications resulting from colonic perforation are related to secondary peritonitis due to bacterial or fecal contamination. We investigated outcomes of emergency surgery for colonic perforation associated with fecal contamination with regard to early and late postoperative complication rates and mortality rates, and investigated prognostic factors influencing those outcomes.
  
  
  METHODS
  A retrospective analysis of prospectively collected data on factors influencing complications and mortality rates was conducted on data from 152 patients who had undergone emergent operations for colonic perforation between January 2005 and December 2011. Patients were categorized into two groups: those with and without gross fecal contamination at the time of operation.
  
  
  RESULTS
  Forty-one (26.9 %) patients had gross fecal contamination. Patients who had fetal contamination had a higher Mannheim peritonitis index (31.3 ± 5.1 vs. 21.9 ± 7.2, p < 0.001), higher organ failure rate (53.7 vs. 24.3 %, p = 0.001), and longer operating time (168.8 ± 49.9 vs. 144.8 ± 66.1 min, p = 0.036) than patients without fecal contamination. Early complications (<30 days) occurred more frequently in the fecal contamination group (82.9 vs. 49.5 %, p = 0.001), although late complications (46.2 vs. 39.3 %, p = 0.942) and mortality (17.1 vs. 8.1 %, p = 0.110) did not differ. In multivariate analysis, fecal contamination significantly predicted early complications (odds ratio, 2.78; p = 0.037) but not late complications or mortality.
  
  
  CONCLUSIONS
  The frequency of early complications can increase if fecal contamination exists. However, when early complications are well managed, fecal contamination does not significantly influence occurrences late complications or mortality.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, 101 Daehangno (28 Yongon-dong), Jongno-Gu, Seoul, 110-744, Republic of Korea.
authors.forename: Eon Chul
authors.initials: EC
authors.lastname: Han
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, 101 Daehangno (28 Yongon-dong), Jongno-Gu, Seoul, 110-744, Republic of Korea. sbryoomd@gmail.com.
authors.forename: Seung-Bum
authors.initials: SB
authors.lastname: Ryoo
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, 101 Daehangno (28 Yongon-dong), Jongno-Gu, Seoul, 110-744, Republic of Korea.
authors.forename: Byung Kwan
authors.initials: BK
authors.lastname: Park
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, 101 Daehangno (28 Yongon-dong), Jongno-Gu, Seoul, 110-744, Republic of Korea.
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Park
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, 101 Daehangno (28 Yongon-dong), Jongno-Gu, Seoul, 110-744, Republic of Korea.
authors.forename: Soo Young
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
authors.forename: Heung-Kwon
authors.initials: HK
authors.lastname: Oh
authors.affiliation: Department of Surgery, Myongji Hospital, Goyang, Gyeonggi, Republic of Korea.
authors.forename: Heon-Kyun
authors.initials: HK
authors.lastname: Ha
authors.affiliation: Seoul National University Hospital Gangnam Center, Seoul, Republic of Korea.
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Choe
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, 101 Daehangno (28 Yongon-dong), Jongno-Gu, Seoul, 110-744, Republic of Korea.
authors.forename: Sang Hui
authors.initials: SH
authors.lastname: Moon
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, 101 Daehangno (28 Yongon-dong), Jongno-Gu, Seoul, 110-744, Republic of Korea.
authors.forename: Seung-Yong
authors.initials: SY
authors.lastname: Jeong
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, 101 Daehangno (28 Yongon-dong), Jongno-Gu, Seoul, 110-744, Republic of Korea.
authors.forename: Kyu Joo
authors.initials: KJ
authors.lastname: Park
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000150:complications* / Q000601:surgery*; D004630:Emergencies; D005243:Feces; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010538:Peritonitis / Q000209:etiology*; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Colonic perforation; Fecal contamination; Morbidity; Mortality; Risk factors