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Surgery for ischemic colitis: outcome and risk factors for in-hospital mortality

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Abstract

Purpose

Surgery for ischemic colitis is associated with high perioperative morbidity and mortality, but the risk factors for mortality and major surgical complications are unclear.

Methods

In this retrospective single institution cohort study of all patients undergoing colorectal surgery for histologically proven ischemic colitis between 2004 and 2010, we evaluated surgical outcomes and risk factors for in-hospital mortality and major surgical complications.

Results

For the 100 patients included in the study, in-hospital mortality was 54 %; major surgical complications, defined as anastomotic leakage or rectal stump and stoma complications, occurred in 16 %. In the multivariable analysis, hospital death was more likely in patients with right-sided (odds ratio [OR] 3.8; 95 % confidence interval [CI] 1.2, 12; P = 0.022) or pan-colonic ischemia (OR 11; 95 % CI 2.8, 39; P < 0.001), both relative to left-sided ischemia. Decreased preoperative pH level (OR 2.5 per 0.1 decrease; 95 % CI 1.5, 4.1; P < 0.001) and prior cardiac or aortic surgery (OR 2.4; 95 % CI 0.82, 6.8; P = 0.109) were further important risk factors for in-hospital mortality. Major postoperative surgical complications were more likely in patients with ischemic alterations at the resection margin of the histological specimen (OR 3.7; 95 % CI 1.2, 11; P = 0.022).

Conclusions

Colonic resection for ischemic colitis is associated with high in-hospital mortality, especially in patients with right-sided or pan-colonic ischemia. In patients developing acidosis, early laparotomy is essential. Since resection margins’ affection seems to be underestimated upon surgery, resections should be performed wide enough within healthy tissue.

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Author information

Authors and Affiliations

  1. Department of Surgery, University Hospital Basel, Basel, Switzerland

    Jörg Genstorfer, Juliane Schäfer, Christoph Kettelhack, Daniel Oertli & Rachel Rosenthal

  2. Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland

    Juliane Schäfer

  3. Department of Visceral Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    Jörg Genstorfer

Authors
  1. Jörg Genstorfer
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  2. Juliane Schäfer
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  3. Christoph Kettelhack
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  4. Daniel Oertli
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  5. Rachel Rosenthal
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Corresponding author

Correspondence to Jörg Genstorfer.

Additional information

1. What is current knowledge

• There is little and contradictory knowledge about perioperative risk factors for mortality and surgical complications in patients undergoing surgery for ischemic colitis.

• If surgery is necessary for acute ischemic colitis, it is associated with high perioperative morbidity and mortality of up to 50 %.

2. What is new here

• In-hospital mortality is significantly elevated in patients with right-sided or pan-colonic ischemia and after cardiac or aortic surgery.

• There is evidence that patients with ischemic alterations at the resection margin of the histological specimen are more likely to experience major postoperative surgical complications.

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Genstorfer, J., Schäfer, J., Kettelhack, C. et al. Surgery for ischemic colitis: outcome and risk factors for in-hospital mortality. Int J Colorectal Dis 29, 493–503 (2014). https://doi.org/10.1007/s00384-013-1819-1

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  • DOI: https://doi.org/10.1007/s00384-013-1819-1

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