Changes in the surgical approach to colonic emergencies during a 15-year period

Dig Surg. 2014;31(3):197-203. doi: 10.1159/000365254. Epub 2014 Aug 28.

Abstract

Purpose: The present study aims to determine the morbidity and mortality of emergency colonic surgery and the factors associated with adverse outcome, and to evaluate any change in incidence of the different types of pathological conditions and in the surgical approach over the last 15 years.

Materials and methods: A total of 319 patients who underwent emergency colonic surgery between January 1997 and December 2011 were retrospectively analyzed. Patients were divided into two groups according to the date of surgery, namely group 1, between 1997 and 2006, and group 2, between 2006 and 2011. The differences in terms of postoperative outcomes between the groups were analyzed.

Results: Overall postoperative morbidity and mortality rates were 25.3 and 17.2%, respectively; no differences were found between the groups. Group 2 showed a significantly increased rate of primary resection and anastomosis (p < 0.001), as well as an increase in laparoscopic approach compared with group 1 (p < 0.001).

Conclusions: Emergency colon surgery is today primarily performed for benign diseases, of these the most common is diverticular disease followed by ischemic colitis. Age, comorbidities, and ischemic colon disease are predictors of adverse outcomes, while the surgical procedure per se is not.

Publication types

  • Comparative Study

MeSH terms

  • Abdomen, Acute / etiology
  • Abdomen, Acute / mortality*
  • Abdomen, Acute / surgery*
  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomosis, Surgical / adverse effects
  • Anastomosis, Surgical / methods
  • Cohort Studies
  • Colectomy / adverse effects
  • Colectomy / methods*
  • Colectomy / mortality
  • Colonic Diseases / mortality
  • Colonic Diseases / pathology
  • Colonic Diseases / surgery*
  • Colonic Neoplasms / mortality
  • Colonic Neoplasms / pathology
  • Colonic Neoplasms / surgery
  • Emergency Treatment / methods
  • Emergency Treatment / mortality*
  • Female
  • Follow-Up Studies
  • Hospital Mortality
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Patient Safety
  • Postoperative Complications / mortality
  • Postoperative Complications / surgery
  • Retrospective Studies
  • Survival Rate
  • Time Factors
  • Treatment Outcome