title: What is the predictor of surgical mortality in adult colorectal perforation? The clinical characteristics and results of a multivariate logistic regression analysis.
abstract: OBJECTIVE
  Colorectal perforations are a serious condition associated with a high mortality. The aim of this study was to describe the clinical characteristics and identify predictors for the surgical mortality in adult patients with colorectal perforation, thereby achieving better outcomes.
  
  
  METHODS
  A retrospective study of adult patients diagnosed with colorectal perforation operated was performed. The clinical variables that might influence the surgical mortality were first analyzed, and the significant variables were then analyzed using a logistic regression model.
  
  
  RESULTS
  A total of 423 patients were identified, and the surgical mortality rate was 36.9 %. The most common etiology was diverticulitis (38.2 %). The highest etiology-specific mortality was for colorectal cancer (61.5 %) and ischemic proctocolitis (59.8 %). In a logistic analysis, the significant predictors for the surgical mortality were ≥3 comorbidities (p = 0.034), preoperation American Society of Anesthesiologists score ≥4 (p = 0.025), preoperative sepsis or septic shock (p < 0.001), colorectal cancer or ischemic proctocolitis (p = 0.035), reoperation (p = 0.041), and Hinchey classification grade IV (p = 0.024).
  
  
  CONCLUSIONS
  We demonstrated that ≥3 comorbidities, a preoperation American Society of Anesthesiologists score ≥4, preoperative sepsis or septic shock, colorectal cancer or ischemic proctocolitis, reoperation, and Hinchey classification grade IV are predictors for the surgical mortality in the adult cases of colorectal perforation. These predictors should be taken into consideration to prevent surgical mortality and to reduce potentially unnecessary medical expenses.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veteran General Hospital, 386 Ta-Chung 1st Road, Kaohsiung, 81346, Taiwan, R.O.C.. ss851124@gmail.com.|Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.. ss851124@gmail.com.
authors.forename: Chao-Wen
authors.initials: CW
authors.lastname: Hsu
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veteran General Hospital, 386 Ta-Chung 1st Road, Kaohsiung, 81346, Taiwan, R.O.C.
authors.forename: Jui-Ho
authors.initials: JH
authors.lastname: Wang
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veteran General Hospital, 386 Ta-Chung 1st Road, Kaohsiung, 81346, Taiwan, R.O.C.|Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
authors.forename: Ya-Hsin
authors.initials: YH
authors.lastname: Kung
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veteran General Hospital, 386 Ta-Chung 1st Road, Kaohsiung, 81346, Taiwan, R.O.C.
authors.forename: Min-Chi
authors.initials: MC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000401:mortality* / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000150:complications; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D004238:Diverticulitis / Q000150:complications; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011350:Proctocolitis / Q000150:complications; D012002:Rectal Diseases / Q000401:mortality* / Q000601:surgery*; D012044:Regression Analysis; D012189:Retrospective Studies
keywords: Colorectal; Perforation; Predictor; Surgical mortality