Surgical outcomes and prognostic factors associated with emergency left colonic surgery

BACKGROUND: Mortality from emergency left-sided colorectal surgery can be substantial due to acuteness of the presentation and the urgent need to operate in the setting of a limited preparation in a morbid patient. OBJECTIVES: Determine the 30-day postoperative outcomes and identify risk factors for complications and mortality following emergency colorectal operations. DESIGN: Retrospective SETTINGS: Three tertiary hospitals in three countries. PATIENTS AND METHODS: Factors that were studied included age, sex, ASA score, type and extent of the operation, and presence/absence of malignancy. Unadjusted 30-day patient outcomes examined were complications and mortality. Differences in proportions were assessed using the Pearson chi-square test while logistic regression analyses were carried out to evaluate the correlation between risk factors and outcomes. MAIN OUTCOME MEASURES: 30-day postoperative morbidity and mortality SAMPLE SIZE: 104 patients. RESULTS: Among 104 patients, 70 (67.3%) were men, and 34 (32.7%) were women. The mean (SD) age was 57.2 (17.1) years. The most common indication for emergency colonic surgery was malignant obstruction in 33 (31.7%) patients. The postoperative complication rate was 24% (25/104), and the mortality rate was 12.5% (13/104) within 30 days of the operation. The ASA status ( P =.02), presence of malignancy ( P =.02), and the presence of complications ( P =.004) were significantly related to mortality in the multivariable logistic regression analysis. CONCLUSIONS: The 30-day mortality of emergency colorectal operations is greatly influenced by the presence of malignancy in the colon and physiological status at the time of the procedure. LIMITATIONS: The retrospective design and small sample size.