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Risk factors for in-hospital mortality after emergency colorectal surgery in octogenarians: results of a cohort study from a referral center.
Mathis, Guillaume; Lapergola, Alfonso; Alexandre, Florent; Philouze, Guillaume; Mutter, Didier; D'Urso, Antonio.
Afiliação
  • Mathis G; Visceral and Digestive Surgery Department, University Hospital, Strasbourg, France.
  • Lapergola A; Visceral and Digestive Surgery Department, University Hospital, Strasbourg, France.
  • Alexandre F; Visceral and Digestive Surgery Department, University Hospital, Strasbourg, France.
  • Philouze G; Visceral and Digestive Surgery Department, University Hospital, Strasbourg, France.
  • Mutter D; Visceral and Digestive Surgery Department, University Hospital, Strasbourg, France.
  • D'Urso A; IRCAD (Research Institute against Digestive Cancer), Strasbourg, France.
Int J Colorectal Dis ; 38(1): 270, 2023 Nov 21.
Article em En | MEDLINE | ID: mdl-37987854
PURPOSE: The objective of this study was to investigate predictive factors of mortality in emergency colorectal surgery in octogenarian patients. METHODS: It is a retrospective cohort study conducted at a single-institution tertiary referral center. Consecutive patients who underwent emergency colorectal surgery between January 2015 and January 2020 were identified. The primary endpoint was 30-day mortality. Univariate and multivariate analyses were performed using a logistic regression model. RESULTS: A total of 111 patients were identified (43 men, 68 women). Mean age was 85.7 ± 3.7 years (80-96). Main diagnoses included complicated sigmoiditis in 38 patients (34.3%), cancer in 35 patients (31.5%), and ischemic colitis in 31 patients (27.9%). An ASA score of 3 or higher was observed in 88.3% of patients. The mean Charlson score was 5.9. The Possum score was 35.9% for mortality and 79.3% for morbidity. The 30-day mortality rate was 25.2%. Univariate analysis of preoperative risk factors for mortality shows that the history of valvular heart disease (p = 0.008), intensive care unit provenance (p = 0.003), preoperative sepsis (p < 0.001), diagnosis of ischemic colitis (p = 0.012), creatinine (p = 0.006) and lactate levels (p = 0.01) were significantly associated with 30-day mortality, and patients coming from home had a lower 30-day mortality rate (p = 0.018). Intraoperative variables associated with 30-day mortality included ileostomy creation (p = 0.022) and temporary laparostomy (p = 0.004). At multivariate analysis, only lactate (p = 0.032) and creatinine levels (p = 0.027) were found to be independent predictors of 30-day mortality, home provenance was an independent protective factor (p = 0.004). Mean follow-up was 3.4 years. Survival at 1 and 3 years was 57.6 and 47.7%. CONCLUSION: Emergency colorectal surgery is challenging. However, age should not be a contraindication. The 30-day mortality rate (25.2%) is one of the lowest in the literature. Hyperlactatemia (> 2mmol/L) and creatinine levels appear to be independent predictors of mortality.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Colite Isquêmica / Cirurgia Colorretal Limite: Aged80 / Female / Humans / Male Idioma: En Revista: Int J Colorectal Dis Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: França País de publicação: Alemanha

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Colite Isquêmica / Cirurgia Colorretal Limite: Aged80 / Female / Humans / Male Idioma: En Revista: Int J Colorectal Dis Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: França País de publicação: Alemanha