Factors Predicting Morbidity and Mortality in Emergency Colorectal Procedures in Elderly Patients

McGillicuddy, Edward A.

doi:10.1001/archsurg.2009.203

Cited by 126 publications

(126 citation statements)

References 36 publications

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“…Some, such as age, urgency of surgery and surgical pathology are less amenable to interventions that improve outcome [35,38]. Thirty-day mortality following emergency small bowel resection, for example, is 21% compared with 8.8% for emergency right hemicolectomy [39].…”

Section: Discussionmentioning

confidence: 99%

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

2013

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SummaryNational reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients. More recently, national audits have reported several-fold variations in the care of elderly emergency surgical patients in the UK [4][5][6], and importantly, these data are beginning to be used to drive quality improvement [11] through professional guidance [12][13][14] that advocates early, focused, multidisciplinary 70

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Section: Discussionmentioning

confidence: 99%

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

2013

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“…51,52 Emergency operation increases the risk of death by more than 3 times in patients with colonic resection [53][54][55][56] and is performed in patients with perforated diverticulitis and peritonitis only.…”

Section: Limitationsmentioning

confidence: 99%

Diverticulitis in immunosuppressed patients: A fatal outcome requiring a new approach?

Brandl

Kratzer

Kafka-Ritsch

et al. 2016

cjs

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“…Emergency colon surgery itself had a higher mortality rate than non-emergency colon surgery [2,[12][13][14]. The present study is of potential interest because sepsis is a very common problem in elderly patients who undergo emergency colorectal surgery.…”

Section: Discussionmentioning

confidence: 76%

“…Our study design did not allow us to explain the exact relationship between the prognosis of patients and the PCT values. Age, septic shock at presentation, large estimated intraoperative blood loss, delayed operation, and development of complications were all associated with inhospital mortality [14]. The relationship between the dynamic changes in PCT and the above complications was extremely complex.…”

Section: Discussionmentioning

confidence: 99%

Value of Serum Procalcitonin in Evaluating the Prognosis of Sepsis in Elderly Patients with Colorectal Cancer Undergoing Emergency Colorectal Surgery

Zou

Cai

et al. 2012

Indian J Surg

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Serum procalcitonin (PCT) levels may have predictive value in the prognosis of postoperative sepsis in elderly patients who have undergone colorectal surgery for colorectal cancer in intensive care units (ICUs). A prospective study involving 90 critically ill patients who underwent colorectal surgery for colorectal cancer in ICUs was performed. Twenty-eight patients were diagnosed with sepsis, in accordance with the American College of Chest Physicians/Society of Critical Care Medicine consensus criteria, and these patients were included in the sepsis group. Sixtytwo patients, who were without evidence of sepsis, were enrolled in the control group. We measured the serum PCT concentrations preoperatively (immediately before induction of anesthesia), upon arrival in the ICU (ICU day 0), on the morning of the first postoperative day (postoperative day 1), and on the morning of the third postoperative day (postoperative day 3). The C-reactive protein (CRP) index, acute physiology and chronic health evaluation II (APACHE II) score, mechanical duration of ventilation, mortality rate, incidence of multiple organ failure, and usage of continuous renal replacement therapy were evaluated. The area under the curve for the receiver operating characteristic curve (AUC-ROCC) was measured to explore the association between the serum PCT and the prognosis. In the sepsis group, 12/28 patients died (mortality rate 43 %). In the control group, 6/ 62 patients died (mortality rate 9.7 %). On the first postoperative day, the serum PCT level was dramatically higher in the sepsis group than in the control group (2.71±1.13 vs. 1.37± 0.57, P≤0.05). The PCT level on the first postoperative day was distinctly higher than that measured upon arrival in the ICU (2.71±1.13 vs. 1.31±0.58, P≤0.05). In the two groups, the CRP concentrations were both markedly higher on the first postoperative day than upon arrival in the ICU (138.89±45.12 vs. 70.43±23.54 in the sepsis group, and 133.13±44.91 vs. 69.65±24.98 in the control group, P≤0.05). Linear regression analysis was performed. The results suggest that the PCT and APACHE-II scores were not significantly associated. On the first and third postoperative days, the PCT levels were associated with increased odds of sepsis (AUC-ROCC, 95 % confidence interval 0.817-0.973, P 00.000, and 0.755-0.944, P00.000, respectively). The outcomes of patients in the sepsis group were worse than those in the control group. PCT levels appear to be early markers of postoperative sepsis in elderly patients undergoing colorectal surgery for colorectal cancer during the ICU course. These findings could allow for early identification of postoperative septic complications and be used for prognostic evaluation of these patients.

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Factors Predicting Morbidity and Mortality in Emergency Colorectal Procedures in Elderly Patients

Cited by 126 publications

References 36 publications

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

Diverticulitis in immunosuppressed patients: A fatal outcome requiring a new approach?

Value of Serum Procalcitonin in Evaluating the Prognosis of Sepsis in Elderly Patients with Colorectal Cancer Undergoing Emergency Colorectal Surgery

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