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Ogawa S, Endo H, Yoshida M, Tsuru T, Itabashi M, Yamamoto H, Kakeji Y, Ueno H, Kitagawa Y, Hibi T, Taketomi A, Ikeda N, Mori M. Effects of the COVID-19 pandemic on short-term postoperative outcomes for colorectal perforation: A nationwide study in Japan based on the National Clinical Database. Ann Gastroenterol Surg 2024; 8:450-463. [PMID: 38707225 PMCID: PMC11066486 DOI: 10.1002/ags3.12758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/14/2023] [Accepted: 10/31/2023] [Indexed: 05/07/2024] Open
Abstract
Aim Possible negative effects of the COVID-19 pandemic on short-term postoperative outcomes for colorectal perforation in Japan were examined in this study. Methods The National Clinical Database (NCD) is a large-scale database including more than 95% of surgical cases in Japan. We analyzed 13 107 cases of colorectal perforation from 2019 to 2021. National data were analyzed, and subgroup analyses were conducted for subjects in prefectures with high infection levels (HILs) and metropolitan areas (Tokyo Met. and Osaka Pref.). Postoperative 30-day mortality, surgical mortality, and postoperative complications (Clavien-Dindo grade ≥3) were examined. Months were considered to have significantly high or low mortality or complication rates, if the 95% confidence interval (CI) of the standardized mortality (morbidity) ratio (SMR) does not contain 1. Results In the NCD, postoperative 30-day mortality occurred in 1371 subjects (10.5%), surgical mortality in 1805 (13.8%), and postoperative complications in 3950 (30.1%). Significantly higher SMRs were found for 30-day mortality in November 2020 (14.6%, 1.39 [95% CI: 1.04-1.83]) and February 2021 (14.6%, 1.48 [95% CI: 1.10-1.96]), and for postoperative complications in June 2020 (37.3%, 1.28 [95% CI: 1.08-1.52]) and November 2020 (36.4%, 1.21 [95% CI: 1.01-1.44]). The SMRs for surgical mortality were not significantly high in any month. In prefectures with HILs and large metropolitan areas, there were few months with significantly higher SMRs. Conclusions The COVID-19 pandemic had limited negative effects on postoperative outcomes in patients with colorectal perforation. These findings suggest that the emergency system for colorectal perforation in Japan was generally maintained during the pandemic.
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Affiliation(s)
- Shimpei Ogawa
- The Japanese Society for Abdominal Emergency MedicineTokyoJapan
- Department of Surgery, Institute of GastroenterologyTokyo Women's Medical UniversityTokyoJapan
| | - Hideki Endo
- Department of Healthcare Quality Assessment, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Masahiro Yoshida
- The Japanese Society for Abdominal Emergency MedicineTokyoJapan
- Department of HBP and Gastrointestinal SurgeryInternational University of Health and WelfareIchikawaJapan
| | - Tomomitsu Tsuru
- The Japanese Society for Abdominal Emergency MedicineTokyoJapan
- Department of Medical Education and Training, Shin‐Koga HospitalKurume, FukuokaJapan
| | - Michio Itabashi
- The Japanese Society for Abdominal Emergency MedicineTokyoJapan
- Department of Surgery, Institute of GastroenterologyTokyo Women's Medical UniversityTokyoJapan
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Yoshihiro Kakeji
- Database Committee, The Japanese Society of Gastroenterological SurgeryTokyoJapan
- Division of Gastrointestinal Surgery, Department of SurgeryKobe University Graduate School of MedicineKobeHyogoJapan
| | - Hideki Ueno
- Database Committee, The Japanese Society of Gastroenterological SurgeryTokyoJapan
- Department of Surgery, National Defense Medical CollegeTokorozawa, SaitamaJapan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
- Department of SurgeryKeio University School of MedicineTokyoJapan
| | - Taizo Hibi
- The Japan Surgical SocietyTokyoJapan
- Department of Pediatric Surgery and TransplantationKumamoto University Graduate School of Medical SciencesKumamotoKumamotoJapan
| | - Akinobu Taketomi
- The Japan Surgical SocietyTokyoJapan
- Department of Gastroenterological Surgery IHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Norihiko Ikeda
- The Japan Surgical SocietyTokyoJapan
- Department of SurgeryTokyo Medical UniversityTokyoJapan
| | - Masaki Mori
- The Japan Surgical SocietyTokyoJapan
- School of MedicineTokai UniversityIseharaKanagawaJapan
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Kudou K, Kajiwara S, Motomura T, Yukaya T, Nakanoko T, Kuroda Y, Okamoto M, Koga T, Yamashita YI. Risk Factors of Postoperative Complication and Hospital Mortality after Colorectal Perforation Surgery. J Anus Rectum Colon 2024; 8:118-125. [PMID: 38689779 PMCID: PMC11056533 DOI: 10.23922/jarc.2023-056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/10/2024] [Indexed: 05/02/2024] Open
Abstract
Objectives Colorectal perforation is associated with high morbidity and mortality rates after surgery. We investigated various clinical features of patients who underwent emergency surgery for colorectal perforation and explored the risk factors for postoperative complications and hospital mortality. Methods Data from 147 patients who underwent surgery for colorectal perforation were retrospectively reviewed. We investigated various clinical and operative factors, including inflammation-based prognostic scores (IBPSs), and evaluated the risk factors for postoperative complications and hospital mortality due to colorectal perforation. Results Among 147 patients, the most frequent postoperative complication was wound infection (32 cases, 21.8%), followed by intra-abdominal abscesses (27 cases, 18.4%) after surgery for colorectal perforation. Time from onset to surgery ≥ 2 days (Hazard ratio [HR] = 2.810, p = 0.0383) and prognostic nutritional index (PNI) < 30 (HR = 3.190, p = 0.0488) were identified as risk factors for intra-abdominal abscess, while neutrophil-lymphocyte ratio (NLR) < 6.15 (HR = 5.020, p = 0.0009) was identified as a risk factor for wound infection. Time from onset to surgery ≥ 2 days (HR = 7.713, p = 0.0492), severe postoperative complications (Clavien-Dindo grade ≥ IIIa) (HR = 10.98, p = 0.0281), and platelet-lymphocyte ratio (PLR) < 144 (HR = 18.84, p = 0.0190) were independent predictive factors for hospital mortality. Conclusions Time from onset to surgery and IBPSs such as PNI, NLR, and PLR, may be associated with postoperative complications and hospital mortality due to colorectal perforation.
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Affiliation(s)
- Kensuke Kudou
- Department of Surgery, Iizuka Hospital, Iizuka, Japan
| | | | | | | | | | - Yosuke Kuroda
- Department of Surgery, Iizuka Hospital, Iizuka, Japan
| | | | - Tadashi Koga
- Department of Surgery, Iizuka Hospital, Iizuka, Japan
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Elnogoomi I, Qasemi H, Aylan Alshamsi M, Alhammadi M, Elnogoomi O. Laparoscopic Repair of Colorectal Perforations Induced by Compressed Air Pressure: A Case Report. Cureus 2024; 16:e56007. [PMID: 38606248 PMCID: PMC11008920 DOI: 10.7759/cureus.56007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
A compressed air nozzle has the potential to result in lethal injuries when handled inappropriately. Owing to the rarity of colorectal perforations due to barotrauma, no clear pathway to managing them has been established. We report an incident of a 33-year-old male patient who presented with tension pneumoperitoneum due to rectosigmoid perforations after being subjected to transanal compressed air insult. An emergency laparoscopic exploration with primary repair of the rectal perforation and Hartmann procedure were performed resulting in a smooth postoperative course. We hereby conclude that laparoscopy is a safe and effective approach associated with faster recovery and fewer adverse events.
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Affiliation(s)
| | - Hoorieh Qasemi
- General Surgery, College of Medicine, University of Sharjah, Sharjah, ARE
| | | | - Majid Alhammadi
- General Surgery, College of Medicine, University of Sharjah, Sharjah, ARE
| | - Omar Elnogoomi
- Surgical Oncology, National Cancer Institute, Cairo University, Cairo, EGY
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Suda K, Shimizu T, Ishizuka M, Miyashita S, Niki M, Shibuya N, Hachiya H, Shiraki T, Matsumoto T, Sakuraoka Y, Mori S, Iso Y, Takagi K, Aoki T, Kubota K. Total Steroid Intake is Associated With Hospital Mortality in Patients With Pan-Peritonitis due to Colorectal Perforation. Am Surg 2023; 89:4764-4771. [PMID: 36301856 DOI: 10.1177/00031348221136576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND Patients with pan-peritonitis (PP) due to colorectal perforation have high mortality rate because colorectal perforation causes septic shock. The association between total steroid intake (TSI) and hospital mortality of such patients is not clear. METHODS One hundred forty-two patients who underwent surgery for PP due to colorectal perforation were reviewed. Patients were divided into two groups by 8000 mg of TSI. The cut-off value of TSI was determined using a receiver operating characteristic curve for hospital mortality. RESULTS The cut-off value of TSI for hospital mortality was 8000 mg. Patients with TSI>8000 mg had high rate of hemodialysis, hospital mortality, and elevated neutrophil ratio (>95%) compared with those with TSI≤8000 mg. Multivariate analyses revealed that TSI (>8000/≤8000, mg) (OR, 9.669; 95% CI, 1.011-92.49; P = .049) was significantly associated with hospital mortality as well as bleeding volume (>1000/≤1000, mL) (OR, 26.08; 95% CI, 3.566-190.4; P = .001), lymphocyte ratio (≤4/>4, %) (OR, 7.988; 95% CI, 1.498-42.58; P = .015) and C-reactive protein (≤7.5/>7.5, mg/dL) (OR, 41.66; 95% CI, 4.784-33.33; P = .001). DISCUSSION There was a significant association between TSI and hospital mortality in patients with PP due to colorectal perforation as well as intraoperative bleeding and systemic inflammatory markers.
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Affiliation(s)
- Kotaro Suda
- Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Takayuki Shimizu
- Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Mitsuru Ishizuka
- Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Shotaro Miyashita
- Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Maiko Niki
- Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Norisuke Shibuya
- Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hiroyuki Hachiya
- Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Takayuki Shiraki
- Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | | | - Yuhki Sakuraoka
- Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Shozo Mori
- Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Yukihiro Iso
- Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Kazutoshi Takagi
- Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Taku Aoki
- Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Keiichi Kubota
- Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan
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Kudou K, Kusumoto T, Hasuda H, Tsuda Y, Kusumoto E, Uehara H, Yoshida R, Sakaguchi Y. Comparison of Laparoscopic and Open Emergency Surgery for Colorectal Perforation: A Retrospective Study. J Laparoendosc Adv Surg Tech A 2023; 33:464-470. [PMID: 36602516 DOI: 10.1089/lap.2022.0423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: This study aimed to clarify the safety and efficacy of laparoscopic surgery for colorectal perforation by comparing the clinical outcomes between laparoscopic and open emergency surgery for colorectal perforation. Materials and Methods: We retrospectively reviewed the data of 116 patients who underwent surgery for colorectal perforation. The patients were categorized into two groups: the open group included patients who underwent laparotomy, and the laparoscopic group included those who underwent laparoscopic surgery. Clinical and operative characteristics and postoperative outcomes were evaluated. Results: The open and laparoscopic groups included 67 and 49 patients, respectively. More than half of the patients in both groups developed perforation in the sigmoid colon (open, 58.2%; laparoscopic, 61.2%). The most common cause of perforation was diverticulum, followed by colorectal cancer. The mean intraoperative blood loss was significantly lower in the laparoscopic group than in the open group (70.0 mL versus 160.3 mL; P = .0290). The incidence of surgical site infection was lower in the laparoscopic group than in the open group (2.0% versus 13.4%; P = .0430). There were no significant differences in either the short- or long-term outcomes between the two groups. Univariate and multivariate analyses showed that the choice of surgical approach (open versus laparoscopic) did not affect overall survival in patients with colorectal perforation. Conclusion: The laparoscopic approach for colorectal perforation in an emergency setting can be safely performed and provides certain advantages over an open approach in suitable patients.
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Affiliation(s)
- Kensuke Kudou
- Department of Surgery, Iizuka Hospital, Japan.,Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Tetsuya Kusumoto
- Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hirofumi Hasuda
- Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yasuo Tsuda
- Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Eiji Kusumoto
- Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hideo Uehara
- Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Rintaro Yoshida
- Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yoshihisa Sakaguchi
- Department of Gastroenterological Surgery, Clinical Research Institute Cancer Research Division, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Matsuda K, Aoki T, Watanabe M, Tomioka K, Tashiro Y, Tomokazu K, Koizumi T, Satoru G, Yamazaki K, Otsuka K, Murakami M. Comparison of Endotoxin Activity Assay and Various Biomarkers for Severity Assessment in Colorectal Perforation Patients. Am Surg 2021:31348211056256. [PMID: 34918954 DOI: 10.1177/00031348211056256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Colorectal perforation is a serious disease with high mortality requiring emergency surgery. This study aimed to evaluate the role of the endotoxin activity assay (EAA) to assess the severity in patients admitted to the intensive care unit after emergency surgeries for colorectal perforations. Patients were divided into high (EAA ≥.4) and low (EAA <.4) groups based on the EAA levels, and the correlation between the EAA values and clinical variables related to the severity was evaluated. The SOFA scores were significantly higher in the high group than those in the low group. The high EAA value persisted even after 48 hours and extended the ICU length of stay. These results suggest that EAA may be a potential biomarker to assess severity and useful as one of the instrumental in predicting the outcomes for colorectal perforation patients.
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Affiliation(s)
- Kazuhiro Matsuda
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, 13059Showa University, Tokyo, Japan
| | - Takeshi Aoki
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, 13059Showa University, Tokyo, Japan
| | - Makoto Watanabe
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, 13059Showa University, Tokyo, Japan
| | - Kodai Tomioka
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, 13059Showa University, Tokyo, Japan
| | - Yoshihiko Tashiro
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, 13059Showa University, Tokyo, Japan
| | - Kusano Tomokazu
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, 13059Showa University, Tokyo, Japan
| | - Tomotake Koizumi
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, 13059Showa University, Tokyo, Japan
| | - Goto Satoru
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, 13059Showa University, Tokyo, Japan
| | - Kimiyasu Yamazaki
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, 13059Showa University, Tokyo, Japan
| | - Koji Otsuka
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, 13059Showa University, Tokyo, Japan
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Duarte JDOM, Pereira PMLP, Sobral ASG, de Oliveira JPR, Rita HJB, de Sousa e Costa JA. Rectal perforation after barium enema: A case report. Clin Case Rep 2019; 7:2565-2567. [PMID: 31893100 PMCID: PMC6935644 DOI: 10.1002/ccr3.2563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 11/23/2022] Open
Abstract
Colorectal perforation after barium enema it is a rare complication, but has a high mortality rate. With the emergence of endoscopic examinations, barium enemas have fallen into disuse and doctors are less aware of its complications. This case is of the utmost importance as failure to recognize it could be fatal.
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Ohki T, Yamamoto M, Miyata H, Sato Y, Saida Y, Morimoto T, Konno H, Seto Y, Hirata K. A comparison of the surgical mortality due to colorectal perforation at different hospitals with data from 10,090 cases in the Japanese National Clinical Database. Medicine (Baltimore) 2017; 96:e5818. [PMID: 28079809 PMCID: PMC5266171 DOI: 10.1097/md.0000000000005818] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Colorectal perforation has a high rate of mortality. We compared the incidence and fatality rates of colorectal perforation among different hospitals in Japan using data from the nationwide surgical database.Patients were registered in the National Clinical Database (NCD) between January 1st, 2011 and December 31st, 2013. Patients with colorectal perforation were identified from surgery records by examining if acute diffuse peritonitis (ADP) and diseases associated with a high probability of colorectal perforation were noted. The primary outcome measures included the 30-day postsurgery mortality and surgical mortality of colorectal perforation. We analyzed differences in the observed-to-expected mortality (O/E) ratio between the two groups of hospitals, that is, specialized and non-specialized, using the logistic regression analysis forward selection method.There were 10,090 cases of disease-induced colorectal perforation during the study period. The annual average postoperative fatality rate was 11.36%. There were 3884 patients in the specialized hospital group and 6206 in the non-specialized hospital group. The O/E ratio (0.9106) was significantly lower in the specialized hospital group than in the non-specialized hospital group (1.0704). The experience level of hospitals in treating cases of colorectal perforation negatively correlated with the O/E ratio.We conducted the first study investigating differences among hospitals with respect to their fatality rate of colorectal perforation on the basis of data from a nationwide database. Our data suggest that patients with colorectal perforation should choose to be treated at a specialized hospital or a hospital that treats five or more cases of colorectal perforation per year. The results of this study indicate that specialized hospitals may provide higher quality medical care, which in turn proves that government policy on healthcare is effective at improving the medical system in Japan.
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Affiliation(s)
- Takeshi Ohki
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University
| | - Hiroaki Miyata
- National Clinical Database
- Department of Health Policy and Management, School of Medicine, Keio University
| | - Yasuto Sato
- Department of Public Health, Tokyo Women's Medical University
| | - Yoshihisa Saida
- Department of Surgery, Toho University Ohashi Medical Centre, Tokyo
| | - Tsuyoshi Morimoto
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki
| | - Hiroyuki Konno
- The Japanese Society of Gastroenterological Surgery, Tokyo
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological Surgery, Tokyo
- Department of Gastrointestinal Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo
| | - Koichi Hirata
- The Japanese Society for Abdominal Emergency Medicine, Tokyo
- First department of surgery of Sapporo Medical university school of Medicine, Sapporo
- Department of Surgery, JR Sapporo Hospital, Sapporo, Japan
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Shimazaki J, Motohashi G, Nishida K, Ubukata H, Tabuchi T. Postoperative arterial blood lactate level as a mortality marker in patients with colorectal perforation. Int J Colorectal Dis 2014; 29:51-5. [PMID: 23846515 PMCID: PMC3898377 DOI: 10.1007/s00384-013-1738-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aims to assess the clinical relevance of postoperative arterial blood lactate (LAC) level as a prognostic factor in patients with colorectal perforation. METHODS Forty-two patients (22 males, 20 females; mean age, 70.8 years) underwent emergency surgery for colorectal perforation. The patients were divided into mortality and survivor groups. As a prognostic scoring system, Acute Physiological and Chronic Health Evaluation II (APACHE-II), Sequential Organ Failure Assessment (SOFA), and Systemic Inflammatory Response Syndrome criteria were calculated. These scores, postoperative LAC level, and other data, including site and etiology of perforation, elapsed time from onset to surgery (eTIME), preoperative white blood cell (WBC) and platelet counts, preoperative C-reactive protein (CRP), and preoperative arterial blood base excess were assessed between the groups. RESULTS The total mortality rate was 33.3 %. On univariate analysis, the APACHE-II and SOFA scores were significantly higher, and eTIME was significantly longer in the mortality group than in the survivor group. The postoperative LAC level was significantly higher in the mortality group (43.1 ± 14.1 mg/dl) than in the survivor group (23.8 ± 12.7 mg/dl; p < 0.001), and the preoperative WBC was significantly lower in the mortality group than in the survivor group. Multivariate logistic regression analysis using the mortality risk factors determined by univariate analysis (eTIME, APACHE-II score, SOFA score, preoperative WBC count, and postoperative LAC) demonstrated that postoperative LAC level was an independent risk factor for mortality. CONCLUSIONS High postoperative LAC level was a useful factor for predicting high mortality rate in patients with colorectal perforation.
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Affiliation(s)
- Jiro Shimazaki
- Department of Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1, Chuo Ami-Machi, Inasiki-Gun, Ibaraki 300-0395 Japan
| | - Gyo Motohashi
- Department of Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1, Chuo Ami-Machi, Inasiki-Gun, Ibaraki 300-0395 Japan
| | - Kiyotaka Nishida
- Department of Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1, Chuo Ami-Machi, Inasiki-Gun, Ibaraki 300-0395 Japan
| | - Hideyuki Ubukata
- Department of Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1, Chuo Ami-Machi, Inasiki-Gun, Ibaraki 300-0395 Japan
| | - Takafumi Tabuchi
- Department of Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1, Chuo Ami-Machi, Inasiki-Gun, Ibaraki 300-0395 Japan
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