J. Zhang1, A. Lubitz1, M. Philp1, Z. Maher1, A. Pathak1, T. Santora1, L. Sjoholm1, A. J. Goldberg1, E. Dauer1 1Temple University,Department Of Surgery,Philadelpha, PA, USA
Introduction: Total abdominal colectomy (TAC) has been associated with morbidity and mortality rates as high as 62% and 28%, respectively. To date, varying findings regarding risk factors for postoperative complications after emergent colectomy have been reported in the literature. We sought to determine if preoperative length of stay impacts morbidity and mortality in patients undergoing emergent TAC.
Methods: We conducted a retrospective cohort study of patients undergoing emergent TAC for any indication at our urban quaternary care institution from 2005-2015 (n=94). Charts were reviewed for patient demographics, preoperative risk factors and Simplified Acute Physiology Score (SAPS), and discrete patient outcomes (leak, abscess, fascial dehiscence, wound infection, hospital length of stay, ventilator days, ICU length of stay and mortality). Patients were then divided into two groups based on whether they underwent TAC prior to hospital day 5 (HD<5) or on hospital day 5 or later (HD≥5). Student’s t-tests were used to compare means for categorical variables, and Chi-squared tests were used to analyze ordinal variables. Statistical analyses were performed using SPSS version 22.
Results: Patients who underwent TAC later in their hospital course had longer total hospital length of stay (Table 1, t=-2.45, df=92, p=0.016) and higher mortality (42.5% v 20.4%, Χ2=5.38, p=0.02). ICU length of stay and ventilator days trended toward being longer in the late group, though these did not reach statistical significance (t=-1.237, df=92, p=0.219 and t=-0.773, df=91, p=0.441, respectively). There was no difference between groups with respect to age, gender, coronary artery disease, hypertension, congestive heart failure, chronic obstructive pulmonary disease, diabetes, chronic kidney disease or stroke. When comparing the early and late operative groups, patient demographics and SAPS did not differ. Intraoperative findings of peritonitis or ischemia also did not differ, nor did postoperative rates of leak, abscess formation, fascial dehiscence or wound infection. Indications for TAC included Clostridium difficile colitis, lower gastrointestinal bleed, large bowel obstruction and inflammatory bowel disease, with more C. diff patients in the early group (Χ2=4.062, p=0.044).
Conclusion: Our data suggest that patients who undergo TAC later in their hospitalization incur longer lengths of stay and greater mortality rates. Age, gender, comorbidities and SAPS scores did not differ among the two groups, suggesting factors external to underlying illness and not reflected in commonly evaluated physiologic markers impact these outcomes.
