Mortality risk factor analysis in colonic perforation: would retroperitoneal contamination increase mortality in colonic perforation?

다국어 초록 (Multilingual Abstract)

Purpose: Colonic perforation is a lethal condition presenting high morbidity and mortality in spite of urgent surgical treatment.
This study investigated the surgical outcome of patients with colonic perforation associated with retroperitoneal contamination.
Methods: Retrospective analysis was performed for 30 patients diagnosed with colonic perforation caused by either inflammation or ischemia who underwent urgent surgical treatment in our facility from January 2005 to December 2014.
Patient characteristics were analyzed to find risk factors correlated with increased postoperative mortality. Using the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) audit system, the mortality and morbidity rates were estimated to verify the surgical outcomes. Patients with retroperitoneal contamination, defined by the presence of retroperitoneal air in the preoperative abdominopelvic CT, were compared to those without retroperitoneal contamination.
Results: Eight out of 30 patients (26.7%) with colonic perforation had died after urgent surgical treatment. Factors associated with mortality included age, American Society of Anesthesiologists (ASA) physical status classification, and the ischemic cause of colonic perforation. Three out of 6 patients (50%) who presented retroperitoneal contamination were deceased. Although the patients with retroperitoneal contamination did not show significant increase in the mortality rate, they showed significantly higher ASA physical status classification than those without retroperitoneal contamination. The mortality rate predicted from Portsmouth POSSUM was higher in the patients with retroperitoneal contamination.
Conclusion: Patients presenting colonic perforation along with retroperitoneal contamination demonstrated severe comorbidity.
However, retroperitoneal contamination was not found to be correlated with the mortality rate.

참고문헌 (Reference)

1 Rhodes A, "The Surviving Sepsis Campaign bundles and outcome : results from the International Multicentre Prevalence Study on Sepsis(the IMPreSS study)" 41 : 1620-1628, 2015

2 Levy MM, "The Surviving Sepsis Campaign : results of an international guideline-based performance improvement program targeting severe sepsis" 36 : 222-231, 2010

3 Copeland GP., "The POSSUM system of surgical audit" 137 : 15-19, 2002

4 Dellinger RP, "Surviving sepsis campaign : international guidelines for management of severe sepsis and septic shock : 2012" 41 : 580-637, 2013

5 Han EC, "Surgical outcomes and prognostic factors of emergency surgery for colonic perforation: would fecal contamination increase morbidity and mortality?" 30 : 1495-1504, 2015

6 Mirilas P, "Surgical anatomy of the retroperitoneal spaces, Part III : Retroperitoneal blood vessels and lymphatics" 76 : 139-144, 2010

7 Moore LJ, "Sepsis in general surgery : a deadly complication" 198 : 868-874, 2009

8 PP SJaT., "Risk prediction in surgery" Jason Smith

9 Tan KK, "Right colonic perforation in an Asian population: predictors of morbidity and mortality" 13 : 2252-2259, 2009

10 Kriwanek S, "Prognostic factors for survival in colonic perforation" 9 : 158-162, 1994

11 Biondo S, "Prognostic factors for mortality in left colonic peritonitis : a new scoring system" 191 : 635-642, 2000

12 Teoh AY, "Outcomes and predictors of mortality and stoma formation in surgical management of colonoscopic perforations : a multicenter review" 144 : 9-13, 2009

13 van der Sluis FJ, "Outcome of surgery for colonoscopic perforation" 14 : e187-e190, 2012

14 Louis DJ, "Morbidity and mortality in octogenarians and older undergoing major intestinal surgery" 52 : 59-63, 2009

15 Leppaniemi A, "Management of abdominal sepsis: a paradigm shift?" 47 : 400-408, 2015

16 Nguyen HB, "Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality" 35 : 1105-1112, 2007

17 Angus DC, "Epidemiology of sepsis: an update" 29 (29): S109-S116, 2001

18 Hecker A, "Diagnostics, therapy and outcome prediction in abdominal sepsis : current standards and future perspectives" 399 : 11-22, 2014

19 Ng HJ, "Current outcomes of emergency large bowel surgery." 97 : 151-156, 2015

20 Lee SL, "Comprehensive reviews of the interfascial plane of the retroperitoneum : normal anatomy and pathologic entities" 17 : 3-11, 2010

21 De Waele J, "Abdominal infections in the intensive care unit : characteristics, treatment and determinants of outcome" 14 : 420-, 2014

22 Gatewood MO, "A quality improvement project to improve early sepsis care in the emergency department" 24 : 787-795, 2015