Ischemic colitis—analysis of risk factors for postoperative mortality
- 173 Downloads
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.
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.
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.
KeywordsIschemic colitis Risk factors Mortality
- 11.Mentha G, Robert J, Rohner A (1990) Results of surgical treatment of ischemic colitis. Hel Chir Acta 57:777–782Google Scholar
- 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
- 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
- 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
- 25.Reeders JW, Tytgat GN, Rosenbusch G, Gramata S (1984) Ischemic colitis. The Hague: Martinus Nijoff 17–28:145–151Google Scholar