Operative mortality in colorectal surgery

Abstract

Summary, Our aim was to examine all postoperative deaths in a colorectal surgical service. We retrospectively examined the records of patients dying within 30 days of surgery in the Colorectal Service, Wellington School of Medicine, New Zealand. There were 16 males (74.4 years) and 17 females (71.9 years). Nineteen patients were admitted during winter. Twenty-one patients underwent emergency operations. Consultants performed 26 operations. Perioperative blood transfusion was needed in 23 patients. Five patients died following surgery for colorectal perforation (! 1.6%). Major bleeding from the colon of rectum was the next commonest indication for surgery in those patients dying postoperatively (8.2%). The disease site was situated in or distal to the sigmoid colon in 22 patients. The postoperative mortality was lowest following right hemicolectomy (0.9%). Patients undergoing colonic bypass surgery had the highest postoperative mortality (12.5%). Patients with ischaemic or radiation-induced disease had high mortality rates (12.5%). 20% of patients suffering pulmonary embolism, 44.4% myocardial infarction, 43.8% congestive heart failure, 50.0% stroke, and 50.0% ARDS died postoperatively. Two patients died within 48 hours of surgery but the remaining deaths occurred after at least 5 days. In patients witb abdominal sepsis of compromised colonic blood flow the avoidance of anastomoses and the performance of peritoneal lavage may contribute to survival. In all other patients mortality is primarily determined by coexistent medical disease.

Anastomotic leak in colorectal surgery: A single surgeon’s experience

“…Postoperative mortality rates in the present study were higher in patients who had suffered anastomotic leakage and this has been documented previously 5,15 . This difference was considerable (24% vs 2.6%) and in major part was due to one group of Wellington patients who developed leaks following ileorectal anastomosis in an emergency setting 16 . It was difficult to explain why ileorectal anastomoses under such circumstances should be associated with such a high morbidity and mortality.…”

“…5,15 This difference was considerable (24% vs 2.6%) and in major part was due to one group of Wellington patients who developed leaks following ileorectal anastomosis in an emergency setting. 16 It was difficult to explain why ileorectal anastomoses under such circumstances should be associated with such a high morbidity and mortality. It may simply have been due to the fact that such patients already had many other comorbidities prior to surgery and that morbidity and mortality in these patients was higher.…”