Advertisement

Langenbeck's Archives of Surgery

, Volume 393, Issue 4, pp 507–512 | Cite as

Ischemic colitis—analysis of risk factors for postoperative mortality

  • Dalibor Antolovic
  • Moritz Koch
  • Ulf Hinz
  • Dominik Schöttler
  • Thomas Schmidt
  • Ulrike Heger
  • Jan Schmidt
  • Markus W. Büchler
  • Jürgen Weitz
Original Article

Abstract

Background

Ischemic colitis is a disease with high postoperative mortality when surgery is necessary. The definition of risk factors for perioperative mortality, which is currently lacking in the literature, could be helpful in clinical decision making and in optimizing perioperative treatment.

Materials and methods

Based on a prospective database, 85 consecutive patients undergoing surgery for ischemic colitis between November 04, 2001 and October, 26, 2004 at the Department of Surgery, University of Heidelberg, were included in this study. The influence of different known factors on perioperative mortality such as age, type of operation, blood loss, comorbidities, hospital course, and complications was tested by univariate and multivariate analysis.

Results

Sixty-seven percent of patients were operated as emergency cases (within 24 h after surgical evaluation). About half of the patients underwent subtotal or total colectomy and 80% had stoma creation. Twenty-two percent of patients developed surgical complications and 47% of patients died in the further postoperative course. Univariate analysis showed underlying cardiovascular diseases, American Society of Anesthesiologists (ASA) status, emergency surgery, total colectomy, elevated intraoperative blood loss and intraoperative allogeneic blood transfusion or transfusion of fresh frozen plasma to be associated with an increased postoperative mortality. Multivariate analysis confirmed ASA status > III, emergency surgery, and blood loss to be independently associated with postoperative mortality in ischemic colitis.

Conclusions

The mortality of patients requiring surgery for ischemic colitis will remain high as the majority of afflicted patients are patients with significant comorbidities in a reduced general condition. But earlier diagnosis and measures to reduce blood loss may contribute to improving the overall outcome.

Keywords

Ischemic colitis Risk factors Mortality 

References

  1. 1.
    Gandhi SK, Hanson MM, Vernava AM, Kaminski DL, Longo WE (1996) Ischemic colitis. Dis Colon Rectum 39:88–100PubMedCrossRefGoogle Scholar
  2. 2.
    Medina C, Vilaseca J, Videla S, Fabra R, Armengol-Miro JR, Malagelada JR (2004) Outcome of patients with ischemic colitis: review of fifty-three cases. Dis Colon Rectum 47:180–184PubMedCrossRefGoogle Scholar
  3. 3.
    Higgins PD, Davis KJ, Laine L (2004) Systematic review: the epidemiology of ischaemic colitis. Aliment Pharmacol Ther 19:729–738PubMedCrossRefGoogle Scholar
  4. 4.
    Green BT, Tendler DA (2005) Ischemic colitis: a clinical review. South Med J 98:217–222PubMedCrossRefGoogle Scholar
  5. 5.
    Pla Marti V, Alos Company R, Ruiz Carmona MD, Solana Bueno A, Roig Vila JV (2001) Experience and results on the surgical and medical treatment of ischaemic colitis. Rev Esp Enferm Dig 93:501–508PubMedGoogle Scholar
  6. 6.
    Longo WE, Ward D, Vernava AM, Kaminski DL (1997) Outcome of patients with total colonic ischemia. Dis Colon Rectum 40:1448–1454PubMedCrossRefGoogle Scholar
  7. 7.
    Scharff JR, Longo WE, Vartanian SM, Jacobs DL, Bahadursingh AN, Kaminski DL (2003) Ischemic colitis: spectrum of disease and outcome. Surgery 134:624–630PubMedCrossRefGoogle Scholar
  8. 8.
    Guttormson NL, Bubrick MP (1989) Mortality from ischemic colitis. Dis Colon Rectum 32:469–472PubMedCrossRefGoogle Scholar
  9. 9.
    Abel ME, Russel TR (1983) Ischemic colitis: comparison of surgical and nonoperative management. Dis Colon Rectum 26:113–115PubMedCrossRefGoogle Scholar
  10. 10.
    West BR, Ray JE, Gathright JB (1980) Comparison of transient ischemic colitis with that requiring surgical treatment. Surg Gynecol Obstet 151:366–368PubMedGoogle Scholar
  11. 11.
    Mentha G, Robert J, Rohner A (1990) Results of surgical treatment of ischemic colitis. Hel Chir Acta 57:777–782Google Scholar
  12. 12.
    Parish KL, Chapman WC, Williams LF (1991) Ischemic colitis—an ever-changing spectrum. Am Surg 57:118–121PubMedGoogle Scholar
  13. 13.
    Flobert C, Cellier C, Berger A, Ngo A, Cuillerier E, Landi B, Martenau P, Cugnenc PH (2000) Right colonic involvement is associated with severe forms of ischemic colitis and occurs frequently in patients with chronic renal failure requiring hemodialysis. Am J Gastroenterol 95:195–198PubMedCrossRefGoogle Scholar
  14. 14.
    Kaminski DL, Keltner RM, Willmann VL (1973) Ischemic colitis. Arch Surg 106:558–563PubMedGoogle Scholar
  15. 15.
    Sakorafas GH, Tsiotos GG (1999) Intra-abdominal complications after cardiac surgery. Eur J Surg 165:820–827PubMedCrossRefGoogle Scholar
  16. 16.
    Schutz A, Eichinger W, Breuer M, Gansera B, Kemkes BM (1998) Acute mesenteric ischemia after open heart surgery. Angiology 49:267–273PubMedCrossRefGoogle Scholar
  17. 17.
    Simic O, Strathausen S, Hess W, Ostermeyer J (1999) Incidence and prognosis of abdominal complications after cardiopulmonary bypass. Cardiovasc Surg 7:419–424PubMedCrossRefGoogle Scholar
  18. 18.
    Mangi AA, Christison-Lagay ER, Torchiana DF, Warshaw LA, Berger DL (2005) Gastrointestinal complications in patients undergoing heart operation. An analysis of 8709 consecutive cardiac surgical patients. Ann Surg 241:895–904PubMedCrossRefGoogle Scholar
  19. 19.
    Guivarc’h M, Roullet-Audy JC, Mosnier H, Boche O (1997) Ischemic colitis. a surgical series of 88 cases. J Chir (Paris) 134:103–108Google Scholar
  20. 20.
    Neary WD, Foy C, Heather BP, Earnshaw JJ (2006) Identifying high-risk patients undergoing urgent and emergency surgery. Ann R Coll Surg Engl 88:151–156PubMedCrossRefGoogle Scholar
  21. 21.
    Bo M , Cacello E, Ghiggia F, Corsinovi L, Bosco F (2006) Predictive factors of clinical outcome in older surgical patients. Arch Gerontol Geriatr, in pressGoogle Scholar
  22. 22.
    Medina-Franco H, Ramos-de la Medina A, Torres-Villalobos G, de Leon HT (2006) Mortality-associated factors in major surgery: retrospective analysis in a referral center. Rev Invest Clin 58:9–14PubMedGoogle Scholar
  23. 23.
    Yi NJ, Han HS, Min SK (2006) The safety of a laparoscopic cholecystectomy in acute cholecystitis in high-risk patients older than sixty with stratification based on ASA score. Minim Invasive Ther Allied Technol 15:159–164PubMedCrossRefGoogle Scholar
  24. 24.
    Suan C, Perez-Torres C, Herrera A (1997) Postoperative mortality in a general hospital. Rev Esp Anestesiol Reanim 44:267–272PubMedGoogle Scholar
  25. 25.
    Reeders JW, Tytgat GN, Rosenbusch G, Gramata S (1984) Ischemic colitis. The Hague: Martinus Nijoff 17–28:145–151Google Scholar
  26. 26.
    Longo WE, Ballantyne GH, Gusberg RJ (1992) Ischemic colitis: patterns and prognosis. Dis Colon Rectum 35:726–730PubMedCrossRefGoogle Scholar
  27. 27.
    Hackert T, Kienle P, Weitz J, Werner J, Szabo G, Hagl S, Buchler MW, Schmidt J (2003) Accuracy of diagnostic laparoscopy for early diagnosis of abdominal complications after cardiac surgery. Surg Endosc 17:1671–1674PubMedCrossRefGoogle Scholar
  28. 28.
    Brunson ME, Alexander JW (1990) Mechanisms of transfusion-induced immunosuppression. Transfusion 30:651–658PubMedCrossRefGoogle Scholar
  29. 29.
    Opelz G, Sengar DPS, Mickey MR, Terasaki PI (1973) Effect of blood transfusions on subsequent kidney transplants. Transplant Proc 5:253–259PubMedGoogle Scholar
  30. 30.
    Duffy G, Kneal KR (1996) Differences in post-operative infection rates between patients receiving autologous and allogenic blood transfusion: a meta-analysis of published randomized and non-randomized studies. Transfus Med 6:325–328PubMedCrossRefGoogle Scholar
  31. 31.
    Vamvakas E, Blajchman M (2001) Deleterious effects of transfusion-associated immunomodulation: fact or fiction? Blood 97:1080–1095CrossRefGoogle Scholar
  32. 32.
    Weitz J, D’Angelica M, Gonen M, Klimstra D, Coit DG, Brennan MF, Karpeh MS (2003) Interaction of splenectomy and perioperative blood transfusions on prognosis of patients with proximal gastric and gastroesophageal junction cancer. J Clin Oncol 21:4597–4503PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Dalibor Antolovic
    • 1
  • Moritz Koch
    • 1
  • Ulf Hinz
    • 1
  • Dominik Schöttler
    • 1
  • Thomas Schmidt
    • 1
  • Ulrike Heger
    • 1
  • Jan Schmidt
    • 1
  • Markus W. Büchler
    • 1
  • Jürgen Weitz
    • 1
    • 2
  1. 1.Department of SurgeryUniversity of HeidelbergHeidelbergGermany
  2. 2.Head Section of Surgical Oncology, Department of SurgeryUniversity of HeidelbergHeidelbergGermany

Personalised recommendations