Hsu Chao-Wen, Wang Jui-Ho, Kung Ya-Hsin, Chang Min-Chi
Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veteran General Hospital, 386 Ta-Chung 1st Road, Kaohsiung, 81346, Taiwan, R.O.C..
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C..
Surg Today. 2017 Jun;47(6):683-689. doi: 10.1007/s00595-016-1415-4. Epub 2016 Sep 20.
Colorectal perforations are a serious condition associated with a high mortality. The aim of this study was to describe the clinical characteristics and identify predictors for the surgical mortality in adult patients with colorectal perforation, thereby achieving better outcomes.
A retrospective study of adult patients diagnosed with colorectal perforation operated was performed. The clinical variables that might influence the surgical mortality were first analyzed, and the significant variables were then analyzed using a logistic regression model.
A total of 423 patients were identified, and the surgical mortality rate was 36.9 %. The most common etiology was diverticulitis (38.2 %). The highest etiology-specific mortality was for colorectal cancer (61.5 %) and ischemic proctocolitis (59.8 %). In a logistic analysis, the significant predictors for the surgical mortality were ≥3 comorbidities (p = 0.034), preoperation American Society of Anesthesiologists score ≥4 (p = 0.025), preoperative sepsis or septic shock (p < 0.001), colorectal cancer or ischemic proctocolitis (p = 0.035), reoperation (p = 0.041), and Hinchey classification grade IV (p = 0.024).
We demonstrated that ≥3 comorbidities, a preoperation American Society of Anesthesiologists score ≥4, preoperative sepsis or septic shock, colorectal cancer or ischemic proctocolitis, reoperation, and Hinchey classification grade IV are predictors for the surgical mortality in the adult cases of colorectal perforation. These predictors should be taken into consideration to prevent surgical mortality and to reduce potentially unnecessary medical expenses.
结直肠穿孔是一种严重疾病，死亡率很高。本研究的目的是描述成年结直肠穿孔患者的临床特征，并确定手术死亡率的预测因素，从而取得更好的治疗效果。
对诊断为结直肠穿孔并接受手术的成年患者进行回顾性研究。首先分析可能影响手术死亡率的临床变量，然后使用逻辑回归模型分析显著变量。
共纳入423例患者，手术死亡率为36.9%。最常见的病因是憩室炎（38.2%）。病因特异性死亡率最高的是结直肠癌（61.5%）和缺血性直肠结肠炎（59.8%）。在逻辑分析中，手术死亡率的显著预测因素为≥3种合并症（p = 0.034）、术前美国麻醉医师协会评分≥4（p = 0.025）、术前脓毒症或感染性休克（p < 0.001）、结直肠癌或缺血性直肠结肠炎（p = 0.035）、再次手术（p = 0.041）和欣奇分类IV级（p = 0.024）。
我们证明，≥3种合并症、术前美国麻醉医师协会评分≥4、术前脓毒症或感染性休克、结直肠癌或缺血性直肠结肠炎、再次手术和欣奇分类IV级是成年结直肠穿孔病例手术死亡率的预测因素。应考虑这些预测因素以预防手术死亡并减少潜在的不必要医疗费用。
