Objective
Emergency colorectal surgery has high rates of morbidity and mortality because of incomplete bowel preparation and bacterial contamination. The aim was to evaluate the surgical outcomes and the risk factors affecting morbidity and mortality in patients who underwent emergency colorectal surgery to treat various complicated colorectal diseases in hope that the results would help lower the perioperative mortality and morbidity rates through alleviation of the identified risk factors.
Patients and methods
This was a prospective study of 50 patients who were admitted to the emergency Department of General Surgery in Sohag University Hospital. The study analyzed the surgical outcomes and risk factors in patients with emergency colorectal diseases who were found in need for emergency colorectal surgery within 24 h. Data were collected for each patient by us and our residents in the emergency department of general surgery. The collected data included the preoperative, intraoperative, and postoperative parameters.
Results
This was a prospective study of 50 patients who underwent emergency colorectal surgery in the Emergency Department of Sohag University Hospital. The data of these studied patients were as follows: 29 (58%) males and 21 (42%) females, with a mean age of 68.92 ± 9.73 years. Perforation (40.0%) was the commonest indication of surgery. Sigmoid colon was the commonest site of lesions (32%). Malignancy was the commonest cause of diseases (28%). Hartmann’s procedure was the commonest operation done (50%). Regarding univariate analysis, age more than or equal to 70 years old, presence of two or more comorbidities, preoperative hypotension, the more the grade of American Society of Anesthesiologist (ASA) score (grades III and IV), perioperative blood transfusion, operative time more than or equal to 170 min, and ischemic colitis were significantly associated with major morbidity [Clavien-Dindo classification grade III or more=23 (46%) patients] and mortality [11 (22%) patients]. With respect to multivariate analysis, age group more than or equal to 70 years, presence of two or more comorbidities, preoperative hypotension, ASA classification grade IV, perioperative blood transfusion, and ischemic colitis were identified as independent risk factors for both major morbidity and mortality.
Conclusion
In this study, emergency colorectal surgery showed relatively high morbidity and mortality rates. Furthermore, the independent risk factors for major morbidity and mortality were age group more than or equal to 70 years, presence of two or more comorbidities, preoperative hypotension, ASA classification grade IV, perioperative blood transfusion, and ischemic colitis. Thus, patients with these characteristics need to be evaluated more carefully and receive better care if the morbidity and mortality rates are needed to be reduced.