Eon Chul Han1, Seung-Bum Ryoo2, Byung Kwan Park1, Ji Won Park1, Soo Young Lee1, Heung-Kwon Oh3, Heon-Kyun Ha4, Eun Kyung Choe5, Sang Hui Moon1, Seung-Yong Jeong1, Kyu Joo Park1. 1. Department of Surgery, Seoul National University College of Medicine, 101 Daehangno (28 Yongon-dong), Jongno-Gu, Seoul, 110-744, Republic of Korea. 2. Department of Surgery, Seoul National University College of Medicine, 101 Daehangno (28 Yongon-dong), Jongno-Gu, Seoul, 110-744, Republic of Korea. sbryoomd@gmail.com. 3. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea. 4. Department of Surgery, Myongji Hospital, Goyang, Gyeonggi, Republic of Korea. 5. Seoul National University Hospital Gangnam Center, Seoul, Republic of Korea.
Abstract
PURPOSE: Complications resulting from colonic perforation are related to secondary peritonitis due to bacterial or fecal contamination. We investigated outcomes of emergency surgery for colonic perforation associated with fecal contamination with regard to early and late postoperative complication rates and mortality rates, and investigated prognostic factors influencing those outcomes. METHODS: A retrospective analysis of prospectively collected data on factors influencing complications and mortality rates was conducted on data from 152 patients who had undergone emergent operations for colonic perforation between January 2005 and December 2011. Patients were categorized into two groups: those with and without gross fecal contamination at the time of operation. RESULTS: Forty-one (26.9 %) patients had gross fecal contamination. Patients who had fetal contamination had a higher Mannheim peritonitis index (31.3 ± 5.1 vs. 21.9 ± 7.2, p < 0.001), higher organ failure rate (53.7 vs. 24.3 %, p = 0.001), and longer operating time (168.8 ± 49.9 vs. 144.8 ± 66.1 min, p = 0.036) than patients without fecal contamination. Early complications (<30 days) occurred more frequently in the fecal contamination group (82.9 vs. 49.5 %, p = 0.001), although late complications (46.2 vs. 39.3 %, p = 0.942) and mortality (17.1 vs. 8.1 %, p = 0.110) did not differ. In multivariate analysis, fecal contamination significantly predicted early complications (odds ratio, 2.78; p = 0.037) but not late complications or mortality. CONCLUSIONS: The frequency of early complications can increase if fecal contamination exists. However, when early complications are well managed, fecal contamination does not significantly influence occurrences late complications or mortality.
PURPOSE: Complications resulting from colonic perforation are related to secondary peritonitis due to bacterial or fecal contamination. We investigated outcomes of emergency surgery for colonic perforation associated with fecal contamination with regard to early and late postoperative complication rates and mortality rates, and investigated prognostic factors influencing those outcomes. METHODS: A retrospective analysis of prospectively collected data on factors influencing complications and mortality rates was conducted on data from 152 patients who had undergone emergent operations for colonic perforation between January 2005 and December 2011. Patients were categorized into two groups: those with and without gross fecal contamination at the time of operation. RESULTS: Forty-one (26.9 %) patients had gross fecal contamination. Patients who had fetal contamination had a higher Mannheim peritonitis index (31.3 ± 5.1 vs. 21.9 ± 7.2, p < 0.001), higher organ failure rate (53.7 vs. 24.3 %, p = 0.001), and longer operating time (168.8 ± 49.9 vs. 144.8 ± 66.1 min, p = 0.036) than patients without fecal contamination. Early complications (<30 days) occurred more frequently in the fecal contamination group (82.9 vs. 49.5 %, p = 0.001), although late complications (46.2 vs. 39.3 %, p = 0.942) and mortality (17.1 vs. 8.1 %, p = 0.110) did not differ. In multivariate analysis, fecal contamination significantly predicted early complications (odds ratio, 2.78; p = 0.037) but not late complications or mortality. CONCLUSIONS: The frequency of early complications can increase if fecal contamination exists. However, when early complications are well managed, fecal contamination does not significantly influence occurrences late complications or mortality.
Authors: Wen-Chih Wu; Tracy S Smith; William G Henderson; Charles B Eaton; Roy M Poses; Georgette Uttley; Vincent Mor; Satish C Sharma; Michael Vezeridis; Shukri F Khuri; Peter D Friedmann Journal: Ann Surg Date: 2010-07 Impact factor: 12.969
Authors: Vasilis A Constantinides; Paris P Tekkis; Thanos Athanasiou; Omer Aziz; Sanjay Purkayastha; Feza H Remzi; Victor W Fazio; Nail Aydin; Ara Darzi; Asha Senapati Journal: Dis Colon Rectum Date: 2006-07 Impact factor: 4.585