Ischemic colitis -: analysis of risk factors for postoperative mortality
Ischemic colitis -: analysis of risk factors for postoperative mortality
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DOI：
10.1007/s00423-008-0300-z
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发表时间：
2008-07-01
影响因子：
2.3
通讯作者：
Weitz, Juergen
中科院分区：
文献类型：
--
作者：
Antolovic, Dalibor;Koch, Moritz;Weitz, Juergen
背景缺血性结肠炎是一种需要手术治疗的术后死亡率高的疾病。围手术期死亡率的危险因素的定义，这是目前缺乏的文献，可能有助于临床决策和优化围手术期treatment.Materials和方法基于前瞻性数据库，85例连续的病人接受手术缺血性结肠炎之间的2001年11月4日和2004年10月26日在外科，海德堡大学，被纳入本研究。不同的已知因素对围手术期死亡率的影响，如年龄，手术类型，失血量，合并症，住院过程，并发症进行了测试，通过单变量和多变量analysis.Results 67%的患者作为急诊病例（手术后24小时内评估）。大约一半的患者接受了次全或全结肠切除术，80%的患者建立了造口。22%的患者发生手术并发症，47%的患者在术后进一步死亡。单变量分析显示，基础心血管疾病、美国麻醉医师协会（阿萨）状态、急诊手术、全结肠切除术、术中失血量增加和术中异体输血或新鲜冷冻血浆输注与术后死亡率增加相关。多变量分析证实阿萨状态> III、急诊手术和失血与缺血性colis.Conclusions术后死亡率独立相关，缺血性结肠炎手术患者的死亡率仍将很高，因为大多数受累患者在一般情况下有显著的合并症。但早期诊断和减少失血的措施可能有助于改善总体结果。
Background Ischemic colitis is a disease with high postoperative mortality when surgery is necessary. The definition of risk factors for perioperative mortality, which is currently lacking in the literature, could be helpful in clinical decision making and in optimizing perioperative treatment.Materials and methods Based on a prospective database, 85 consecutive patients undergoing surgery for ischemic colitis between November 04, 2001 and October, 26, 2004 at the Department of Surgery, University of Heidelberg, were included in this study. The influence of different known factors on perioperative mortality such as age, type of operation, blood loss, comorbidities, hospital course, and complications was tested by univariate and multivariate analysis.Results Sixty-seven percent of patients were operated as emergency cases (within 24 h after surgical evaluation). About half of the patients underwent subtotal or total colectomy and 80% had stoma creation. Twenty-two percent of patients developed surgical complications and 47% of patients died in the further postoperative course. Univariate analysis showed underlying cardiovascular diseases, American Society of Anesthesiologists (ASA) status, emergency surgery, total colectomy, elevated intraoperative blood loss and intraoperative allogeneic blood transfusion or transfusion of fresh frozen plasma to be associated with an increased postoperative mortality. Multivariate analysis confirmed ASA status > III, emergency surgery, and blood loss to be independently associated with postoperative mortality in ischemic colitis.Conclusions The mortality of patients requiring surgery for ischemic colitis will remain high as the majority of afflicted patients are patients with significant comorbidities in a reduced general condition. But earlier diagnosis and measures to reduce blood loss may contribute to improving the overall outcome.