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ORIGINAL ARTICLE
Year : 2019  |  Volume : 38  |  Issue : 3  |  Page : 583-587

Colorectal emergencies: are there any modifiable factors affecting outcome?


Department of General Surgery, Cairo University Hospitals, Kasr Alainy, Egypt

Correspondence Address:
MD, FRCS Eng, FACS Doaa A Mansour
8 Nour Eldin Bahgat Street, Nasr City, Cairo 11371
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejs.ejs_80_19

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Background Colorectal emergencies are common and associated with significant mortality. Emergency presentation per se is an independent risk factor for postoperative morbidity and mortality. The aim of this study is to define modifiable factors to account for the high morbidity and mortality in colorectal emergencies. Patients and methods A total of 137 colorectal emergencies presenting to Kasr Alainy Emergency Department were managed according to the general condition of the patient, site and severity of pathology, bowel wall edema, and friability as well as the experience of the surgical team. Morbidity and 30-day mortality were analyzed using univariate followed by multivariate analysis to determine modifiable factors to improve outcome. Studied factors were patient factors (demographic and comorbidities), site of pathology, presence or absence of malignancy, hemodynamic instability, local pathology, and the treatment adopted. Results Mean age was 45.6 years. Of 48.2% females and 51.8% males, 52.6% presented with colorectal cancer-related emergencies, 7.3% with colorectal trauma, and the remaining 40.1% with nononcological pathology (40.1%). Postoperative morbidity and mortality occurred in 18.2 and 20.4%, respectively. Hemodynamic instability after initial resuscitation harbored the highest risk for mortality in the multivariate module (R=6.6), followed by malignancy (R=3.9), type of operative management (R=1.7), and comorbidity (R=1.4). Conclusion Comorbidity and colorectal malignancy are independent nonmodifiable factors increasing perioperative mortality warranting vigilance. Hemodynamic instability after initial resuscitation is the single most important modifiable factor emphasizing the importance of maximized joint efforts in preoperative optimization of these patients using damage control resuscitation principles. Operative time is an important modifiable factor dictating the shortest appropriate surgical option.


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