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- Table 1
Preoperative and intraoperative characteristics of patients with ischemic colitis
Characteristics Total, n (%) Survivors, n (%) Non-survivors, n (%) P value Age 68.5±14.33 67.33±14.68 71.97±12.60 <0.001 Sex 0.381 Male 1936 (42.5) 1460 (43) 476 (41.4) Female 2609 (57.4) 1935 (56.9) 674 (58.6) Race/ethnicity 0.309 White 3565 (78.4) 2669 (78.5) 896 (77.9) Black or African-American 501 (11.0) 381 (11.2) 120 (10.4) Asian 64 (1.4) 49 (1.4) 15 (1.3) American Indian/Alaskan 27 (0.6) 22 (0.6) 5 (0.4) Hawaiian/Pacific Islander 9 (0.2) 8 (0.2) 1 (0.1) Other 382 (8.4) 269 (7.9) 113 (9.8) Body mass index 28.35±8.03 28.50±7.95 27.90±8.24 0.036 Diabetes 1210 (26.6) 878 (25.8) 332 (28.9) 0.044 Smoker 1140 (25.1) 845 (24.9) 295 (25.7) 0.596 Dyspnea <0.001 At rest 319 (7.0 174 (5.1) 145 (12.6) Moderate exertion 441 (9.7) 305 (9.0) 136 (11.8) Functional status <0.001 Independent 3628 (81.2) 2841 (84.7) 787 (70.8) Partial dependent 491 (10.8) 330 (9.8) 161 (14.5) Totally dependent 348 (7.7) 185 (5.5) 163 (14.7) Vent dependency 824 (18.1) 381 (11.2) 443 (38.5) <0.001 History of severe chronic obstructive pulmonary disease 824 (18.1) 535 (15.7) 289 (25.1) <0.001 Ascites 269 (5.9) 174 (5.1) 95 (8.3) <0.001 Congestive heart failure 306 (6.7) 179 (5.3) 127 (11) <0.001 Hypertension 3272 (71.9) 2387 (70.2) 885 (77.0) <0.001 Preoperative acute renal failure 425 (9.3) 264 (7.8) 161 (14.0) <0.001 Preoperative dialysis 510 (11.2) 302 (8.9) 208 (18.1) <0.001 Disseminated cancer 123 (2.7) 77 (2.3) 46 (4.0) 0.002 Open or infected wounds 302 (6.6) 191 (5.6) 111 (9.7) <0.001 Chronic steroid use 423 (9.3) 295 (8.7) 128 (11.1) 0.013 Weight loss >10% 195 (4.3) 118 (3.5) 77 (6.7) <0.001 Bleeding disorder 178 (3.9) 130 (3.8) 48 (4.2) 0.523 Preoperative systemic sepsis <0.001 Systemic Inflammatory Response Syndrome (SIRS) 570 (12.5) 475 (14.0) 95 (8.3) Sepsis 1328 (29.2) 1021 (30.1) 307 (26.7) Septic shock 1383 (30.4) 783 (23.1) 600 (52.2) Transfusions 72 hours before OR 454 (10.0) 271 (8.0) 183 (15.9) <0.001 Preoperative Na 137.5±4.93 137.38±4.69 137.08±5.53 <0.001 Preoperative blood urea nitrogen 32.5±22.28 29.99±20.99 39.91±24.24 <0.001 Preoperative creatinine 1.90±1.65 1.77±1.62 2.26±1.68 <0.001 Preoperative white blood cells 15.38±8.51 15.19±8.05 15.95±9.71 0.010 Preoperative hematocrit 36.53±7.41 37.03±7.27 35.03±7.58 <0.001 Preoperative platelet 299.1±107.21 233.69±101.91 215.49±120.58 <0.001 Preoperative PTT 35.12±14.74 33.85±13.94 38.45±16.20 <0.001 Preoperative INR 1.45±0.76 1.36±0.66 1.68±0.93 <0.001 Operative time 110.44±70.13 111.47±70.80 107.40±68.04 0.089 Total length of stay 11, IQR (7–19) 12, IQR (8–21) 8, IQR (3–16) <0.001 Days from admission to operation 1, IQR (0–2) 0, IQR (0–1) 1, IQR (0–3) <0.001 Wound classification One clean 46 (1.0) 33 (1.0) 13 (1.1) <0.001 Two clean/contaminated 1039 (22.8) 842 (24.8) 197 (17.1) Three contaminated 1590 (35.0) 1252 (36.8) 338 (29.4) Four dirty/infected 1873 (41.2) 1271 (37.4) 602 (52.3) American Society of Anesthesiologists classification <0.001 1 33 (0.7) 33 (1.0) 0 2 322 (7.1) 312 (9.2) 10 (0.9) 3 1434 (31.5) 1284 (37.8) 150 (13.0) 4 2272 (50.0) 1556 (45.8) 716 (62.3) 5 476 (10.5) 210 (6.2) 266 (23.1) Surgical approach* <0.001 Ex-lap 2763 (95.7) 1971 (94.6) 792 (98.5) Laparoscopic 125 (4.3) 113 (5.4) 12 (1.5) Extent of colectomy† <0.001 Partial 2437 (84.4) 1796 (86.2) 641 (79.7) Total 451 (15.6) 288 (13.8) 163 (20.3) Laterality of colectomy‡ 0.392 Right hemicolectomy 753 (64.0) 558 (63.3) 195 (66.1) Left hemicolectomy 423 (36.0) 323 (36.7) 100 (33.9) Ostomy or anastomosis§ 0.944 Ostomy only 894 (35.5) 654 (35.5) 240 (35.7) Anastomosis only 1585 (63.0) 1161 (63.0) 424 (63.0) Anastomosis with ostomy 36 (1.5) 28 (1.5) 9 (1.3) ∗n=2888, 63.5%.
†n=2888, 63.5%.
‡n=1176, 25.9%.
§n=2516, 55.3%.
- Table 2
30-day outcomes of colectomy for ischemic colitis
Total,
n (%)Survivors,
n (%)Non-survivors,
n (%)P value Mortality 1150 (25.3) – – – In-hospital 945 (20.8) – – – Wound complications Superficial SSI 242 (5.3) 229 (6.7) 13 (1.1) <0.001 Deep SSI 79 (1.7) 68 (2.0) 11 (1.0) 0.019 Organ/space SSI 269 (5.9) 210 (6.2) 59 (5.1) 0.192 Wound disruption 117 (2.6) 101 (3.0) 16 (1.4) 0.003 Respiratory complications Pneumonia 614 (13.5) 424 (12.5) 190 (16.5) 0.001 Unplanned intubation 502 (11.0) 312 (9.2) 190 (16.5) <0.001 Vent >48 hours 1599 (35.2) 1069 (31.5) 530 (46.1) <0.001 Renal complications Progressive renal insufficiency 101 (2.2) 73 (2.1) 28 (2.4) 0.569 Acute renal failure 275 (6.0) 125 (3.7) 150 (13.0) <0.001 UTI 206 (4.5 171 (5.0) 35 (3.0) 0.005 Cardiovascular complications Pulmonary embolism 39 (0.9) 37 (1.1) 2 (0.2) 0.004 Stroke/CVA 88 (1.9) 50 (1.5) 38 (3.3) <0.001 Cardiac arrest 221 (4.9) 42 (1.2) 179 (15.6) <0.001 Myocardial infarction 163 (3.6) 107 (3.1) 56 (4.9) 0.007 DVT 154 (3.4) 125 (3.7) 29 (2.5) 0.061 Postoperative bleeding/transfusions 1725 (37.9) 1103 (32.5) 622 (54.1) <0.001 Sepsis complications Sepsis 465 (10.2) 384 (11.3) 81 (7.0) <0.001 Septic shock 1194 (26.3) 658 (19.4) 536 (46.6) <0.001 Return to OR 652 (14.3) 463 (13.6) 189 (16.4) 0.019 Unplanned reoperation 364 (11.7) 264 (11.3) 100 (12.8) 0.266 CVA, cerebrovascular accident; DVT, deep vein thrombosis; SSI, surgical site infection; UTI, urinary tract infection.
- Table 3
Multivariate model showing predictive factors for 30-day mortality following colectomy for ischemic colitis
Variable OR 95% CI P value Lower Upper Age group (years) 18–40 Reference 41–64 1.68 0.98 2.90 0.061 65–79 3.36 1.96 5.74 <0.001 >80 5.13 2.97 8.86 <0.001 Comorbidities 0 Reference 1 1.76 1.23 2.51 0.002 2 2.65 1.87 3.76 <0.001 3 3.10 2.15 4.47 <0.001 >4 4.45 3.06 6.47 <0.001 Functional status Independent Reference Partially dependent 1.29 1.03 1.61 0.026 Fully Dependent 1.65 1.28 2.13 <0.001 Septic shock (preoperative) 2.80 2.39 3.29 <0.001 Transfusions (preoperative) 1.40 1.11 1.76 0.005 Renal failure (preoperative) 3.06 2.32 4.03 <0.001 Days to surgery 0 Reference 1 0.99 0.82 1.20 0.939 2 1.04 0.78 1.38 0.795 >3 1.39 1.14 1.70 0.001
Predictive factors of mortality after colectomy in ischemic colitis: an ACS-NSQIP database study
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