Annals of Coloproctology

Original Articles

Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation: Rumi Shin, Sang Mok Lee, Beonghoon Sohn, Dong Woon Lee, Inho Song, Young Jun Chai, Hae Won Lee, Hye Seong Ahn, In Mok Jung, Jung Kee Chung, Seung Chul Heo; Ann Coloproctol. 2016;32(6):221-227. Published online December 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.6.221

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34 Citations

Purpose

An intestinal perforation is a rare condition, but has a high mortality rate, even after immediate surgical intervention. The clinical predictors of postoperative morbidity and mortality are still not well established, so this study attempted to identify risk factors for postoperative morbidity and mortality after surgery for an intestinal perforation.

Methods

We retrospectively analyzed the cases of 117 patients who underwent surgery for an intestinal perforation at a single institution in Korea from November 2008 to June 2014. Factors related with postoperative mortality at 1 month and other postoperative complications were investigated.

Results

The mean age of enrolled patients was 66.0 ± 15.8 years and 66% of the patients were male. Fifteen patients (13%) died within 1 month after surgical treatment. Univariate analysis indicated that patient-related factors associated with mortality were low systolic and diastolic blood pressure, low serum albumin, low serum protein, low total cholesterol, and high blood urea nitrogen; the surgery-related factor associated with mortality was feculent ascites. Multivariate analysis using a logistic regression indicated that low systolic blood pressure and feculent ascites independently increased the risk for mortality; postoperative complications were more likely in both females and those with low estimated glomerular filtration rates and elevated serum C-reactive protein levels.

Conclusion

Various factors were associated with postoperative clinical outcomes of patients with an intestinal perforation. Morbidity and mortality following an intestinal perforation were greater in patients with unstable initial vital signs, poor nutritional status, and feculent ascites.

Citations

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Long-term Outcomes and Risk Factors for Reoperation After Surgical Treatment for Gastrointestinal Crohn Disease According to Anti-tumor Necrosis Factor-α Antibody Use: 35 Years of Experience at a Single Institute in Korea: Sang Mok Lee, Eon Chul Han, Seung-Bum Ryoo, Heung-Kwon Oh, Eun Kyung Choe, Sang Hui Moon, Joo Sung Kim, Hyun Chae Jung, Kyu Joo Park; Ann Coloproctol. 2015;31(4):144-152. Published online August 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.4.144

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6 Web of Science
7 Citations

Abstract PDF

Purpose

Crohn disease is characterized by high rates of recurrence and reoperations. However, few studies have investigated long-term surgical outcomes in Asian populations. We investigated risk factors for reoperation, particularly those associated with anti-tumor necrosis factor-α (anti-TNF-α) antibody use, and long-term follow-up results.

Methods

We reviewed the records of 148 patients (100 males and 48 females) who underwent surgery for gastrointestinal Crohn disease and retrospectively analyzed long-term outcomes and risk factors.

Results

The mean age at diagnosis was 28.8 years. Thirty-eight patients (25.7%) received monoclonal antibody treatment before reoperation. A small bowel and colon resection was most commonly performed (83 patients, 56.1%). The median follow-up was 149 months, during which 47 patients underwent reoperation. The median interval between the primary and the secondary surgeries was 65 months, with accumulated reoperation rates of 16.5%, 31.8%, and 57.2% after 5, 10, and 15 years, respectively. Obstruction was the most common indication for reoperation (37 patients, 25.0%). In a multivariable analysis, age <17 years at diagnosis (A1) (odds ratio [OR], 2.20; P = 0.023), penetrating behavior (B3) (OR, 4.39; P < 0.001), and no azathioprine use (OR, 2.87; P = 0.003) were associated with reoperation. Anti-TNF-α antibody use did not affect the reoperation rate (P = 0.767).

Conclusion

We showed a high reoperation rate regardless of treatment with anti-TNF-α antibody, which indicates that recurrent surgery is still needed to cure patients with gastrointestinal Crohn diseases. Younger age at primary operation, penetrating behavior, and no azathioprine use were significant factors associated with reoperation for gastrointestinal Crohn disease.

Citations

Citations to this article as recorded by

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Mafalda Santiago, Fernando Magro, Luís Correia, Francisco Portela, Paula Ministro, Paula Lago, Eunice Trindade, Cláudia Camila Dias
Clinical and Translational Gastroenterology.2020; 11(9): e00227. CrossRef
Effect of Thiopurine on Potential Surgical Intervention in Crohn’s Disease in Korea: Results from the CONNECT Study
Hee Man Kim, Jin Woo Kim, Hyun-Soo Kim, Joo Sung Kim, You Sun Kim, Jae Hee Cheon, Won Ho Kim, Byong Duk Ye, Won Moon, Sung Hee Jung, Young-Ho Kim, Dong Soo Han
Journal of Clinical Medicine.2020; 10(1): 25. CrossRef
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Stanislaus Argeny, Anton Stift, Martina Mittlböck, Amy C. Lord, Svenja Maschke, Mathias Schneeweiß, Stefan Riss
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Medical Science Monitor.2016; 22: 3722. CrossRef
Endoscopy-based management decreases the risk of postoperative recurrences in Crohn’s disease
Anne-Laure Boucher, Bruno Pereira, Stéphanie Decousus, Marion Goutte, Felix Goutorbe, Anne Dubois, Johan Gagniere, Corinne Borderon, Juliette Joubert, Denis Pezet, Michel Dapoigny, Pierre J Déchelotte, Gilles Bommelaer, Anthony Buisson
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Anti-tumor Necrosis Factor Therapy for Crohn Disease: Friend or Foe to the Surgeon?
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