Predictors of mortality following emergency open colectomy for ischemic colitis: a single-center experience

Abstract

Background: Ischemic colitis (IC) is a severe emergency in gastrointestinal surgery. The aim of the present study was to identify the predictors of postoperative mortality after emergent open colectomy for IC treatment. Additionally, we compared postoperative outcomes of patients undergoing emergent colectomy due to aortic surgery-related IC (AS-IC group) vs. other IC etiologies (Other-IC group). Methods: We analyzed records of consecutive patients who underwent emergency open colectomy for IC between 2008 and 2019. Logistic regression analysis was performed to identify clinical and operative parameters associated with postoperative mortality. The AS-IC and Other-IC groups were compared for mortality, morbidity, ICU stay, hospital stay, and survival. Results: During the study period, 94 patients (mean age, 67.4 ± 13.7 years) underwent emergent open colectomy for IC. In the majority of cases, IC involved the entire colon (53.2%) and vasopressor agents were required preoperatively (63.8%) and/or intraoperatively (78.8%). Thirty-four patients underwent surgery due to AS-IC, whereas 60 due to Other-IC causes. In the AS-IC group, 9 patients had undergone endovascular aortic repair and 25 open aortic surgery; 61.8% of patients needed aortic surgery for ruptured abdominal aortic aneurism (AAA). Overall, 66 patients (70.2%) died within 90 days from surgery. The AS-IC and Other-IC groups showed similar operative outcomes and postoperative complication rates. However, the duration of the ICU stay (19 days vs. 11 days; p = 0.003) and of the total hospital stay (22 days vs. 16 days; p = 0.016) was significantly longer for the AS-IC group than for the Other-IC group. The rate of intestinal continuity restoration at 1 year after surgery was higher for the Other-IC group than for the AS-IC group (58.8% vs. 22.2%; p = 0.05). In the multivariate model, preoperative increased lactate levels, a delay between signs/symptoms' onset and surgery > 12 h, and the occurrence of postoperative acute kidney injury were statistically associated with postoperative mortality. Neither IC etiology (aortic surgery vs. other etiology) nor ruptured AAA was associated with postoperative mortality. Conclusion: Emergency open colectomy for IC is associated with high postoperative mortality, which appears to be unrelated to the IC etiology. Preoperative lactate levels, > 12-h delay to surgery, and postoperative acute kidney injury are independent predictors of postoperative mortality.

Open Surgery for Abdominal Aortic Aneurysm: 980 Consecutive Patient Outcomes from a High-Volume Centre in the United Kingdom

“…21,22 Colonic ischaemia can be particularly difficult to diagnose and even after emergency colectomy the risk of mortality is high. 23,24 The median length of stay overall in hospital stay was 10 days, for elective repair 9 days and emergency repair 15 days. The level of care required for immediate post-operative care in elective patients was a specialist vascular ward for one-third, HDU for one-half, and only 14.2% needing admission to the ICU.…”

“… 21 , 22 Colonic ischaemia can be particularly difficult to diagnose and even after emergency colectomy the risk of mortality is high. 23 , 24 …”

Lactulose-Induced Ischemic Colitis: A Rare Presentation and an Overview of Possible Etiologies of the Disease

“…Elderly patients with ischemic colitis experience a mortality rate of 29% based on higher lactate levels and comorbidities [ 16 ]. The postoperative mortality after emergency open colectomy in ischemic colitis cases is attributed to postoperative acute kidney injury, delay in surgery, and elevated levels of preoperative lactates [ 17 ]. However, ischemic colitis in the treated patient proved fatal despite appropriate diagnostic management.…”

Prevalence and predictive value of sarcopenia in hospitalized patients with ischemic colitis

“…The prevalences of severe IC (48.6% vs. 20.2%; P < 0.001) and deep ulcers (31.5% vs. 14.0%; P = 0.003) were higher among patients with sarcopenia defined as SMA/BMI than in among those without sarcopenia (Table 3). Patients with sarcopenia also had significantly prolonged median hospital stays (8 [6-11] vs. 6 [5][6][7][8] days; P < 0.001), fasting duration (4 [3][4][5][6][7] vs. 3 [2][3][4] days; P = 0.004), and prolonged antibiotic use (9 [5][6][7][8][9][10][11][12][13] vs. 7 [4][5][6][7][8][9][10][11][12] days; P = 0.039). Nine (4.0%) patients underwent bowel surgery, and all had sarcopenia defined as SMA/BMI (Supplementary Table 1).…”