title: Improving results of surgery for fecal peritonitis due to perforated colorectal disease: A single center experience.
abstract: OBJECTIVE
  fecal peritonitis due to colorectal perforation is a dramatic event characterized by high mortality. Our study aims at determining how results of sigmoid resection (eventually extended to upper rectum) for colorectal perforation with fecal peritonitis changed in recent years and which factors affected eventual changes.
  
  
  METHODS
  Seventy-four patients were operated on at our institution (2005-2014) for colorectal perforation with fecal peritonitis and were divided into two numerically equal groups (operated on before (ERA1-group) and after (ERA2-group) May 2010). Mannheim Peritonitis Index (MPI) was calculated for each patient. Characteristics of two groups were compared. Predictors of postoperative outcomes were identified.
  
  
  RESULTS
  Postoperative overall complications, major complications, and mortality occurred in 59%, 28%, and 18% of cases, respectively, and were less frequent in ERA2-group (51%, 16%, and 8%, respectively), compared to ERA1-group (68%, 41%, and 27%, respectively; p = .155, .02, and .032, respectively). Such results paralleled lower MPI values in ERA2-group, compared to ERA1-group (23(16-39) vs. 28(21-43), p = .006). Using receiver operating characteristic analysis, the best cut-off value for MPI for predicting postoperative complications and mortality was 28.5. MPI>28 was the only independent predictor of postoperative overall (p = .009, OR = 4.491) and major complications (p < .001, OR = 23.182) and was independently associated with a higher risk of mortality (p = .016, OR = 13.444), as well as duration of preoperative peritonitis longer than 24 h (p = .045, OR = 17.099).
  
  
  CONCLUSIONS
  results of surgery for colorectal perforation with fecal peritonitis have improved over time, matching a concurrent decrease of MPI values and a better preoperative patient management. MPI value may help in selecting patients benefitting from surgical treatment.
authors.affiliation: Department of Chirurgia Generale e Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100 Torino, Italy. Electronic address: mmineccia@mauriziano.it.
authors.forename: Michela
authors.initials: M
authors.lastname: Mineccia
authors.affiliation: Department of Chirurgia Generale e Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100 Torino, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Zimmitti
authors.affiliation: Department of Chirurgia Generale e Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100 Torino, Italy; Department of Chirurgia Epatobilio-Pancreatica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141 Milano, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Ribero
authors.affiliation: Department of Chirurgia Generale e Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100 Torino, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Giraldi
authors.affiliation: Department of Chirurgia Generale e Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100 Torino, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Bertolino
authors.affiliation: Piedmont Monitoring Center for Drug Abuse Epidemiology, ASL Torino 3, Via Sabaudia 164, Grugliasco, 10095 Torino, Italy.
authors.forename: Romeo
authors.initials: R
authors.lastname: Brambilla
authors.affiliation: Department of Chirurgia Generale e Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100 Torino, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ferrero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods / Q000401:mortality*; D012809:Colon, Sigmoid / Q000601:surgery*; D005243:Feces; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010538:Peritonitis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Colorectal perforation; Fecal peritonitis; Hartmann's procedure; Mannheim Peritonitis Index; Primary anastomosis