Unit of Digestive and HPB surgery, CARE Department, Henri Mondor Hospital, AP-HP, and Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
Unit of vascular surgery, CARE Department, Henri Mondor Hospital, AP-HP, and Université Paris Est, UPEC, Créteil, France.
World J Emerg Surg. 2020 Jun 29;15(1):40. doi: 10.1186/s13017-020-00321-4.
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).
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.
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.
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.
缺血性结肠炎（IC）是胃肠道手术中的一种严重急症。本研究旨在确定因 IC 治疗而行急诊剖腹结肠切除术患者的术后死亡率的预测因素。此外，我们比较了因主动脉手术相关 IC（AS-IC 组）和其他 IC 病因（Other-IC 组）而行急诊结肠切除术的患者的术后结局。
我们分析了 2008 年至 2019 年期间因 IC 而行急诊剖腹结肠切除术的连续患者记录。采用逻辑回归分析确定与术后死亡率相关的临床和手术参数。比较 AS-IC 组和 Other-IC 组的死亡率、发病率、重症监护病房住院时间、总住院时间和生存率。
在研究期间，94 例（平均年龄 67.4 ± 13.7 岁）患者因 IC 而行急诊剖腹结肠切除术。大多数情况下，IC 累及整个结肠（53.2%），术前（63.8%）和/或术中（78.8%）需要使用血管加压药。34 例患者因 AS-IC 而行手术，60 例患者因 Other-IC 病因而行手术。AS-IC 组中，9 例患者接受了血管内主动脉修复，25 例患者接受了开放主动脉手术；61.8%的患者因破裂的腹主动脉瘤（AAA）需要主动脉手术。总体而言，66 例患者（70.2%）在术后 90 天内死亡。AS-IC 组和 Other-IC 组的手术结果和术后并发症发生率相似。然而，AS-IC 组的 ICU 住院时间（19 天 vs. 11 天；p = 0.003）和总住院时间（22 天 vs. 16 天；p = 0.016）明显长于 Other-IC 组。术后 1 年时，Other-IC 组的肠连续性恢复率高于 AS-IC 组（58.8% vs. 22.2%；p = 0.05）。多变量模型显示，术前乳酸水平升高、症状/体征出现至手术的时间延迟>12 小时以及术后急性肾损伤与术后死亡率具有统计学相关性。IC 病因（主动脉手术与其他病因）或破裂的 AAA 均与术后死亡率无关。
因 IC 而行急诊剖腹结肠切除术与术后死亡率较高相关，而这似乎与 IC 的病因无关。术前乳酸水平、>12 小时的手术延迟和术后急性肾损伤是术后死亡率的独立预测因素。
