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

Genstorfer, J; Schäfer, Juliane; Kettelhack, Christoph; Oertli, Daniel; Rosenthal, Rachel

doi:10.1007/s00384-013-1819-1

Cited by 30 publications

(21 citation statements)

References 47 publications

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“…In almost all of the patients who died, the development of MOF and septic shock were significantly associated with postoperative mortality. These findings are in agreement with those in recent studies involving more than 100 patients who underwent surgery for IC, MOF and sepsis were found to be the principle causes of death [ 2 , 3 ]. Sepsis is a common postoperative complication in IC patients, and has been shown to be associated with postoperative mortality [ 4 , 14 ].…”

Section: Discussionsupporting

confidence: 93%

“…High rates of postoperative morbidity and mortality have been reported in patients with ischemic colitis who require surgery [ 1 , 2 , 9 - 12 ]. The mortality rates have been reported to range from 28% to 54%, and high morbidity rates ranging from 21% to 85% have been reported in patients with ischemic colitis requiring surgery [ 1 - 3 , 9 , 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

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Poor prognostic factors in patients who underwent surgery for acute non-occlusive ischemic colitis

et al. 2015

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IntroductionIschemic colitis (IC) is a disease with high postoperative morbidity and mortality. Knowledge of the risk factors for postoperative mortality could be helpful in clinical decision making and in optimizing postoperative treatment.MethodsFrom a prospective database, we conducted a retrospective medical record review of 50 patients who underwent surgery for IC between 2003 and 2011 at our institution. We analyzed the causes and potential risk factors for early mortality after surgery for IC.ResultsThe early postoperative mortality and morbidity rates were 30.0% (15/50) and 54% (27/50), respectively. The two most common causes of death were multi-organ failure (66.7%, 10/15) and fulminant septic shock (20.0%, 3/15). Univariate analysis showed that postoperative mortality was significantly associated with preoperative nephropathy, coronary artery disease, a previous history of cardiovascular surgery, an ASA score ≥ 4, surgical delay ≥ 3 days, preoperative hemodynamic instability, and use of pre- and intraoperative adrenergic vasopressors. In the multivariate analysis, a previous history of cardiovascular surgery (odds ratio [OR], 8.2; 95% confidence interval [CI], 1.2–56.5) and surgical delay ≥ 3 days (OR, 5.7; 95% CI, 1.2–27.9) were identified as independent risk factors for postoperative mortality.ConclusionsBecause surgical delay is an avoidable determinant of early mortality, a high index of suspicion and early surgical intervention can increase survival. A routine postoperative evaluation for IC may be helpful in patients with a previous history of cardiovascular surgery.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Poor prognostic factors in patients who underwent surgery for acute non-occlusive ischemic colitis

et al. 2015

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“…For example, a study by Genstorfer et al found a 3.8 and 11 times OR for death in right-sided colitis and pan colitis compared with left, respectively. 9 Longstreth and Yao found a 14.6 times OR for death in right-sided and bilateral colitis together when compared with left-sided colitis. 3 In contrast, our large sample database study showed that there was no significant difference in laterality of colectomy between survivors and non-survivors.…”

Section: Discussionmentioning

confidence: 97%

“… 3 4 6 8 10–13 Other studies also identified laterality of ischemia, extent of surgical resection and etiology of ischemia on specimen pathology to be predictive of mortality as well. 9 …”

Section: Introductionmentioning

confidence: 99%

Predictive factors of mortality after colectomy in ischemic colitis: an ACS-NSQIP database study

Tseng

Loper

Jain

et al. 2017

Trauma Surg Acute Care Open

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BackgroundSurgical intervention for ischemic colitis is associated with significant postoperative morbidity and mortality. Predictive factors of adverse outcomes have been reported in the literature, but are based on small sample populations. We sought to identify risk factors for mortality after emergent colectomy for ischemic colitis using a clinical outcomes database.MethodsThe American College of Surgeons National Surgical Quality Improvement Project database was queried from 2010 to 2015 to identify emergent colectomies performed for ischemic colitis using Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes. Univariate and multivariate logistic regression analysis was used to identify independent risk factors associated with increased risk of mortality.ResultsA total of 4548 patients undergoing emergent colectomies for ischemic colitis were identified. Overall, 30-day postoperative mortality was 25.3%. On univariate analysis, preoperative risk factors associated with a higher rate of mortality include dyspnea, functional status, ventilator dependency, history of chronic obstructive pulmonary disease, ascites, congestive heart failure exacerbation, hypertension, dialysis dependency, cancer, open wounds, chronic steroids, weight loss >10%, transfusions within 72 hours before surgery, septic shock and duration from hospital admission to surgery. Factors that were significant for mortality on logistic regression analysis include elderly age, poor functional status, multiple comorbidities, septic shock, blood transfusion, acute renal failure and the duration of time from hospital admission to surgery.ConclusionsPostoperative morbidity and mortality rates for ischemic colitis remain significantly high. Identification of risk factors may help patient selection for surgical interventions, and make informed decisions with patients and family members. Although it is certainly challenging, early diagnosis and prompt surgical intervention for patients with ischemic colitis may improve outcomes.Study type and level of evidenceTherapeutic/care management, level II

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Dear Editor:We read with interest the recent paper by Genstorfer et al [1] that described outcomes and risk factors for in-hospital mortality following surgery for ischaemic colitis. The authors draw attention to a common morbid surgical condition that is frequently fatal.

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confidence: 99%

Improving outcomes from ischaemic colitis: more questions than answers

Gardiner

McGivney

McGuire

et al. 2014

Int J Colorectal Dis

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Dear Editor:We read with interest the recent paper by Genstorfer et al. [1] that described outcomes and risk factors for in-hospital mortality following surgery for ischaemic colitis. The authors draw attention to a common morbid surgical condition that is frequently fatal. We appreciate that such retrospective cohort studies have many weaknesses as acknowledged by the authors in their discussion. However, we would like to highlight a few significant limitations of this study that require further clarification.First, we were disappointed to note that the presence of known risk factors of adverse surgical outcomes such as diabetes and patient smoking status were not recorded or included in this analysis. In particular, diabetic hyperglycaemia is associated with acidaemia, ketosis and impaired wound healing [2]. Given that reduced preoperative pH level was reported as an important risk factor for inhospital mortality, we found it surprising that the influence of this potential confounding factor was not discussed.Second, the authors report that prior cardiac or aortic surgery was an independent risk factor for in-hospital mortality. However, this conclusion seems somewhat overstated as the results presented suggest, if anything, a weak non-significant association only (OR 2.4; 95 % CI 0.82 to 6.8; P=0.109). In addition, it is unclear why the authors presented postoperative death as "in-patient death" rather than the more conventional 30-day post-operative mortality. This makes comparison with previously published series difficult.Finally, the finding that major post-operative surgical complications were more likely to occur in patients with histologically proven ischaemic changes at the resection margin appears to be at odds with the authors contradictory comment in the discussion that "primary anastomosis can be performed, when blood supply of the residual colon and the formed anastomosis seems to be sufficient in the eyes of an experienced surgeon". Therefore, it would be of interest if the authors could have measured whether the intraoperative assessment of colonic viability correlated well with subsequent histological evaluation.We agree with the authors that larger, prospective, multicentre cohort studies are required to further evaluate predictors of mortality and surgical complications in patients undergoing surgery for ischaemic colitis. It is hoped that identification of clinically relevant factors will not only hasten the accurate diagnosis of ischaemic colitis but also ensure appropriate surgical management, with the aim of reducing the burden of morbidity and mortality associated with this condition. Conflict of interest

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

Cited by 30 publications

References 47 publications

Poor prognostic factors in patients who underwent surgery for acute non-occlusive ischemic colitis

Poor prognostic factors in patients who underwent surgery for acute non-occlusive ischemic colitis

Predictive factors of mortality after colectomy in ischemic colitis: an ACS-NSQIP database study

Improving outcomes from ischaemic colitis: more questions than answers

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