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

doi:10.3393/ac.2016.32.6.221

Articles

Page Path: HOME > Ann Coloproctol > Volume 32(6); 2016 > Article

Original Article Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation: Rumi Shin, Sang Mok Lee, Beonghoon Sohn, Dong Woon Lee¹, Inho Song¹, Young Jun Chai, Hae Won Lee, Hye Seong Ahn, In Mok Jung, Jung Kee Chung, Seung Chul Heo; Annals of Coloproctology 2016;32(6):221-227.
DOI: https://doi.org/10.3393/ac.2016.32.6.221
Published online: December 31, 2016

Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.

¹Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

Correspondence to: Seung Chul Heo, M.D. Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea. Tel: +82-2-870-2273, Fax: +82-2-870-3866, heosc3@brmh.org

• Received: September 12, 2016 • Accepted: October 23, 2016

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

prev next

9,642 Views
89 Download
36 Web of Science
38 Crossref
33 Scopus

Full Article

Download PDF

Abstract
INTRODUCTION
METHODS
RESULTS
DISCUSSION
ARTICLE INFORMATION
REFERENCES

Abstract

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.
Keywords: Intestinal perforations; Postoperative mortality; Postoperative complications; Ascites

INTRODUCTION

An intestinal perforation is a major life-threatening condition with high morbidity and mortality that requires emergency surgery. Despite improvements in surgical and medical treatments, the overall mortality rate is 30% and the mortality rate of cases that also have diffuse peritonitis is up to 70% [1 2 3 4]. The rate of postoperative complications, such as complicated fluid collection, leakage, surgical site infection, and other systemic infections, is higher than for patients receiving elective abdominal surgeries. Various factors can cause intestinal perforation, including ischemic colitis, intestinal obstruction, stercoral perforation, infection, cancer, diverticulitis, trauma, and colonoscopy [2 5 6]. Perforations due to cancer and infection have high mortality rates [7 8], but iatrogenic perforation during colonoscopy has a low mortality rate [9]. Several studies have identified prognostic factors associated with morbidity and mortality for patients with an intestinal perforation [1 10], and several scoring systems are available [11 12]. However, these risk factors and scoring systems have only been validated in small study populations and are not clinically useful in emergency situations. Thus, the aim of the present study was to identify simple and intuitive patient-related and surgery-related prognostic factors associated with postoperative morbidity and mortality for patients with an intestinal perforation.

METHODS

This retrospective study was performed at the Seoul Metropolitan Government-Seoul National University Boramae Medical Center. From November 2008 to June 2014, 123 consecutive patients underwent an exploratory laparotomy due to a suspected intestinal perforation. Of those, the 117 patients who were over 18 years of age and who had confirmed intestinal perforations were included in this study. Clinical data, laboratory data, and operative findings were collected by reviewing their medical records. Postoperative complications were defined as complicated fluid collection, anastomosis leakage, surgical site infection, ileus, pneumonia, entero-cutaneous fistula, cardiovascular events, multiorgan failure, and septic shock. The study protocol was approved by the Institutional Review Board of Seoul Metropolitan Government-Seoul National University Boramae Medical Center (approval number: 26-2016-115).

The chi-square test or Fisher exact test was used to compare survivors and nonsurvivors. A multivariable logistic regression model was used to the calculate odds ratios (ORs) and the 95% confidence intervals (95% CIs) and to identify factors independently associated with postoperative mortality. The multivariable model was constructed using a forward Wald test, with adjustment for age, sex, body mass index (BMI), surgical procedure, feculent ascites, fever, time from symptom onset to surgery, time from admission to surgery, length of surgery, initial systolic and diastolic blood pressure, heart rate, and comorbidities. The 1-month postoperative survival curve was estimated using the Kaplan-Meier method, and the log-rank test was used to determine the significance of differences according to the presence of feculent ascites. For all analyses, a two-tailed P-value of 0.05 or less was considered significant. All statistical analyses were performed using IBM SPSS Statistics ver. 19.0 (IBM Co., Armonk, NY, USA).

RESULTS

The mean age of enrolled patients was 66.0 ± 15.8 years, and 66% were male. The most common causes of intestinal perforation were complications from endoscopy (15.4%) and complicated diverticulitis (12.0%) (Table 1). Resection and anastomosis (R&A) was the most common operation (Fig. 1). The mean time from symptom onset to surgery was 2.1 ± 1.7 days, and that from admission to surgery was 35.9 ± 92.0 hours.

Fifteen patients (12.8%) died within 1 month after the index surgery. Table 2 shows the factors associated with postoperative mortality. Analysis of patient-related factors indicated that de-ceased patients had lower initial systolic blood pressure (121.6 ± 26.2 mmHg vs. 100.8 ± 28.1 mmHg, P = 0.005) and diastolic blood pressure (73.7 ± 15.2 mmHg vs. 53.5 ± 17.1 mmHg, P < 0.001), and lower levels of serum albumin (3.3 ± 0.6 g/dL vs. 3.0 ± 0.5 g/dL, P = 0.048), serum protein (5.6 ± 1.2 g/dL vs. 4.9 ± 1.5 g/dL, P = 0.032), and total cholesterol (124.6 ± 4.97 mg/dL vs. 97.0 ± 50.0 mg/dL, P = 0.047), but a higher level of blood urea nitrogen (25.3 ± 20.6 mg/dL vs. 40.1 ± 33.4 mg/dL, P = 0.020). Analysis of surgery-related factors indicated that feculent ascites (19.6% vs. 53.3%, P = 0.008) was significantly more common in deceased patients. The multivariate analysis using a logistic regression model indicated that feculent ascites (OR, 4.948; P = 0.007; 95% CI, 1.564–15.654) and systolic blood pressure less than 100 mmHg (OR, 4.399; P = 0.013; 95% CI, 1.367–14.156) were inde-pendent and significant risk factors for postoperative mortality (Table 3). In agreement, the Kaplan-Meier survival analysis showed that the 1-month mortality was greater for patients with feculent ascites than those with non-feculent ascites (29.6% vs. 8.2%, Log-rank test: P = 0.003) (Fig. 2).

Postoperative complications occurred in 70 patients (60%) (Fig. 3). The most common complications were surgical site infection (n = 21), pneumonia (n = 18), and complicated fluid collection (n = 18). The highest mortality rates occurred in patients with multiorgan failure (100%), cardiovascular events (50%), and septic shock (42%). Table 4 shows the results of the univariate analysis of factors associated with postoperative complications. The results show that advanced age (P = 0.012), female sex (P = 0.017), hypertension (P = 0.004), feculent ascites (P = 0.016), low white blood cell count (P = 0.012), low serum albumin (P = 0.001), and low estimated glomerular filtration rate (eGFR) (P < 0.001) were significantly associated with complications. The multivariate analysis (Table 5) indicated that low eGFR (P = 0.021), female sex (P = 0.045), and elevated C-reactive protein level (CRP) (P = 0.017) were significantly and independently associated with complications. Feculent ascites was a marginally significant factor (P = 0.051).

DISCUSSION

The purpose of this study was to identify the major predictors of morbidity and mortality after surgery for an intestinal perforation. Previous researchers reported that general colorectal surgery had an overall mortality rate of 3%–7% and a morbidity rate of 20%–30% [13 14]. In the case of surgery for an intestinal perforation, however, the reported mortality rate is 10%–15% and the morbidity rate is 30%–50% [1 15]. In our study, the mortality rate was 13%, and the morbidity rate was 60%, in agreement with previous reports. The main results of this study are that low systolic blood pressure and feculent ascites are independent predictors of postoperative mortality, and that low eGRF, female sex, and high CRP are independent predictors of postoperative complications.

A previous study of patients with a stercoral perforation of the colon indicated that intra-abdominal infection was the second most common cause of septic shock after pulmonary infection [16]. Preoperative shock, usually septic shock, is a well-established risk factor for mortality following intestinal perforation. Septic shock caused by an intestinal perforation results from direct spillage of intestinal contents into the peritoneum (feculent ascites). This leads to entry of gram-negative and anaerobic bacteria, including Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis, into the peritoneal cavity [17]. These bacteria produce endotoxins that activate inflammatory cascades, leading to the release of cytokines, such as tumor necrosis factor-alpha, interleukin (IL)-1, and IL-6, resulting in septic shock. Shinkawa et al. [10] previously reported that the in-hospital mortality from colonic perforation was 8 times higher in patients with septic shock than in those without septic shock. Several scoring systems that consider a patient's initial status to predict prognosis, such as the Acute Physiology and Chronic Health Evaluation II score [18] and the Simplified Acute Physiology Score, are available [19]. These scoring systems can be used to predict the prognosis of patients with intestinal perforations; however, they do not consider disease-specific conditions [12]. In this study, low initial systolic blood pressure and feculent ascites were significant and independent predictors of postoperative mortality. This means that pre-operative sepsis is the most important factor associated with postoperative mortality.

Other research has established that malnutrition is independently associated with poor clinical outcomes among hospitalized patients, including longer hospital stay, increased costs, increased morbidity, and increased mortality, regardless of the underlying disease [20 21]. Nutritional status can be evaluated by using tools such as the Subjective Global Assessment [22 23], the Mini Nutritional Assessment [24], and the Malnutrition Clinical Characteristics [25] tools. Previous research has validated these scoring systems, but these tools typically cannot be used in patients un-dergoing emergency operations. Serum albumin is a widely accepted indicator of nutritional status [26], although some controversy exists because albumin is a negative acute-phase reactant and hypoalbuminemia is a sign of systemic inflammation [27]. However, serum albumin is a better prognostic indicator than other scoring systems because it indicates protein-energy malnu-trition resulting from the stress of illness, injury, or infection [28], all of which are associated with significantly increased risk of morbidity and mortality [29 30 31]. Serum albumin is also well known to be associated with surgical outcomes. For example, Gibbs et al. [32] reported that serum albumin concentration was a better predictor of surgical outcomes than many other preoperative factors in patients undergoing noncardiac surgery. Truong et al. [33] reported a linear relationship between hypoalbuminemia and morbidity and mortality following colorectal surgery. The present study also indicated that hypoalbuminemia was associated with poor surgical outcomes in patients with an intestinal perforation, although it was not a statistically independent risk factor for poor outcome.

We also identified factors related to complications following surgery for an intestinal perforation. Age, low BMI, chronic kidney disease, poor American Society of Anesthesiologists physical status, large blood loss, and long operation time are generally known to be risk factors for postoperative complications [34 35 36]. In the present study, feculent ascites and high CRP (indicators of severe intra-abdominal infection and inflammation) and impaired renal function were independently and significantly associated with complications. We were surprised to find that female sex increased the risk for complications. This may be due to the females in this study being older than the males (68.4 ± 15.4 years vs. 64.8 ± 16.0 years) or to postoperative pneumonia being more common in the females in this study than the males (28.2% vs. 9.0%, P = 0.012).

This study has some limitations that need to be emphasized. First, it was a retrospective study, so some variables that could be related with outcomes, such as pH from atrial blood gas analysis and the results of blood cultures, were not evaluated. Second, this was a single center study, so the results may not be applicable to other populations. Finally, because intestinal perforation is a rare condition, the study population was relatively small. This made estimating the prognostic values of some variables, such as age or time from admission to surgery, impossible.

In conclusion, the postoperative mortality of patients with an intestinal perforation was greater for those with low systolic blood pressure and feculent ascites. Females, as well as patients with low eGFR or high CRP, had increased risk of postoperative complications. Patients with any of these prognostic factors should be given more meticulous intraoperative and postoperative care to improve their outcomes.

ARTICLE INFORMATION

CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.

REFERENCES

1. Bielecki K, Kamiński P, Klukowski M. Large bowel perforation: morbidity and mortality. Tech Coloproctol 2002;6:177–182. Article PubMed
2. Kriwanek S, Armbruster C, Beckerhinn P, Dittrich K. Prognostic factors for survival in colonic perforation. Int J Colorectal Dis 1994;9:158–162. Article PubMed
3. Pisanu A, Cois A, Uccheddu A. Surgical treatment of perforated diverticular disease: evaluation of factors predicting prognosis in the elderly. Int Surg 2004;89:35–38. PubMed
4. Ohmann C, Wittmann DH, Wacha H. Prospective evaluation of prognostic scoring systems in peritonitis. Peritonitis Study Group. Eur J Surg 1993;159:267–274. PubMed
5. Kriwanek S, Armbruster C, Dittrich K, Beckerhinn P. Perforated colorectal cancer. Dis Colon Rectum 1996;39:1409–1414. Article PubMed
6. Serpell JW, Nicholls RJ. Stercoral perforation of the colon. Br J Surg 1990;77:1325–1329. Article PubMed
7. Kyllönen LE. Obstruction and perforation complicating colorectal carcinoma. An epidemiologic and clinical study with special reference to incidence and survival. Acta Chir Scand 1987;153:607–614. PubMed
8. Welch JP, Donaldson GA. Perforative carcinoma of colon and rectum. Ann Surg 1974;180:734–740. Article PubMed PMC
9. Samalavicius NE, Kazanavicius D, Lunevicius R, Poskus T, Valantinas J, Stanaitis J, et al. Incidence, risk, management, and outcomes of iatrogenic full-thickness large bowel injury associated with 56,882 colonoscopies in 14 Lithuanian hospitals. Surg Endosc 2013;27:1628–1635. Article PubMed
10. Shinkawa H, Yasuhara H, Naka S, Yanagie H, Nojiri T, Furuya Y, et al. Factors affecting the early mortality of patients with nontraumatic colorectal perforation. Surg Today 2003;33:13–17. Article PubMed
11. Biondo S, Ramos E, Deiros M, Ragué JM, De Oca J, Moreno P, et al. Prognostic factors for mortality in left colonic peritonitis: a new scoring system. J Am Coll Surg 2000;191:635–642. Article PubMed
12. Horiuchi A, Watanabe Y, Doi T, Sato K, Yukumi S, Yoshida M, et al. Evaluation of prognostic factors and scoring system in colonic perforation. World J Gastroenterol 2007;13:3228–3231. Article PubMed PMC
13. Alves A, Panis Y, Mathieu P, Mantion G, Kwiatkowski F, Slim K, et al. Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study. Arch Surg 2005;140:278–283. Article PubMed
14. Ko CY, Chang JT, Chaudhry S, Kominski G. Are high-volume surgeons and hospitals the most important predictors of in-hospital outcome for colon cancer resection? Surgery 2002;132:268–273. Article PubMed
15. Han EC, Ryoo SB, Park BK, Park JW, Lee SY, Oh HK, et al. Surgical outcomes and prognostic factors of emergency surgery for colonic perforation: would fecal contamination increase morbidity and mortality? Int J Colorectal Dis 2015;30:1495–1504. Article PubMed
16. Engel C, Brunkhorst FM, Bone HG, Brunkhorst R, Gerlach H, Grond S, et al. Epidemiology of sepsis in Germany: results from a national prospective multicenter study. Intensive Care Med 2007;33:606–618. Article PubMed
17. Pavlidis TE. Cellular changes in association with defense mechanisms in intra-abdominal sepsis. Minerva Chir 2003;58:777–781. PubMed
18. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829. Article PubMed
19. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270:2957–2963. Article PubMed
20. Lew CC, Yandell R, Fraser RJ, Chua AP, Chong MF, Miller M. Association between malnutrition and clinical outcomes in the intensive care unit: a systematic review. JPEN J Parenter Enteral Nutr 2016;2 02 [Epub]. Article
21. Hu WH, Cajas-Monson LC, Eisenstein S, Parry L, Cosman B, Ramamoorthy S. Preoperative malnutrition assessments as predictors of postoperative mortality and morbidity in colorectal cancer: an analysis of ACS-NSQIP. Nutr J 2015;14:91.Article PubMed PMC
22. Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 1987;11:8–13. Article PubMed
23. Coltman A, Peterson S, Roehl K, Roosevelt H, Sowa D. Use of 3 tools to assess nutrition risk in the intensive care unit. JPEN J Parenter Enteral Nutr 2015;39:28–33. Article PubMed
24. Guigoz Y, Vellas B, Garry PJ. Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation. Nutr Rev 1996;54(1 Pt 2): S59–S65.Article
25. White JV, Guenter P, Jensen G, Malone A, Schofield M, et al. Academy of Nutrition and Dietetics Malnutrition Work Group. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet 2012;112:730–738. Article PubMed
26. Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg 1980;139:160–167. Article PubMed
27. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999;340:448–454. Article PubMed
28. Lipschitz DA. Protein calorie malnutrition in the hospitalized elderly. Prim Care 1982;9:531–543. Article PubMed
29. Moghadamyeghaneh Z, Hwang G, Hanna MH, Phelan MJ, Carmichael JC, Mills SD, et al. Even modest hypoalbuminemia affects outcomes of colorectal surgery patients. Am J Surg 2015;210:276–284. Article PubMed
30. Kong CH, Guest GD, Stupart DA, Faragher IG, Chan ST, Watters DA. Colorectal preOperative Surgical Score (CrOSS) for mortality in major colorectal surgery. ANZ J Surg 2015;85:403–407. Article PubMed
31. Detsky AS, Baker JP, O'Rourke K, Johnston N, Whitwell J, Mendelson RA, et al. Predicting nutrition-associated complications for patients undergoing gastrointestinal surgery. JPEN J Parenter Enteral Nutr 1987;11:440–446. Article PubMed
32. Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg 1999;134:36–42. Article PubMed
33. Truong A, Hanna MH, Moghadamyeghaneh Z, Stamos MJ. Implications of preoperative hypoalbuminemia in colorectal surgery. World J Gastrointest Surg 2016;8:353–362. Article PubMed PMC
34. Manilich E, Vogel JD, Kiran RP, Church JM, Seyidova-Khoshknabi D, Remzi FH. Key factors associated with postoperative complications in patients undergoing colorectal surgery. Dis Colon Rectum 2013;56:64–71. Article PubMed
35. Cohen ME, Bilimoria KY, Ko CY, Hall BL. Development of an American College of Surgeons National Surgery Quality Improvement Program: morbidity and mortality risk calculator for colorectal surgery. J Am Coll Surg 2009;208:1009–1016. Article PubMed
36. Slim K, Panis Y, Alves A, Kwiatkowski F, Mathieu P, Mantion G, et al. Predicting postoperative mortality in patients undergoing colorectal surgery. World J Surg 2006;30:100–106. Article PubMed

Fig. 1

Surgical methods used to treat patients with intestinal perforations (n = 117). R&A, resection and anastomosis.

Fig. 2

Kaplan-Meier analysis of 30-day mortality in patients with feculent ascites and nonfeculent ascites after surgery for an intestinal perforation. A log-rank test indicated significantly greater mortality in patients with feculent ascites.

Fig. 3

Incidences and mortality rates of postoperative complications after surgery for an intestinal perforation.

Table 1

Etiology of the intestinal perforation in the study population (n = 117)

Table 2

Univariate analysis of patient-related and operation-related factors associated with mortality within one month after surgery for an intestinal perforation

Values are presented as mean ± standard deviation or number (%) unless otherwise indicated.

eGFR, estimated glomerular filtration rate; PT INR, prothrombin time international normalized ratio; aPTT, activated partial thromboplastin time; R&A, resection and anastomosis.

^*P < 0.05, statistically significant.

Table 3

Multivariable analysis of factors associated with mortality within one month after surgery for an intestinal perforation

OR, odds ratio; CI, confidence interval; sBP, systolic blood pressure.

^*P < 0.05, statistically significant.

Table 4

Univariate analysis of patient-related and surgery-related factors associated with postoperative complications within 1 month after surgery for an intestinal perforation^a

Values are presented as number (%).

eGFR, estimated glomerular filtration rate.

^aComplications are in Fig. 3. ^*P < 0.05, statistically significant.

Table 5

Multivariable analysis of factors associated with postoperative complications within one month after an intestinal perforation

OR, odds ratio; CI, confidence interval; eGFR, estimated glomerular filtration rate; CRP, C-reactive protein.

^*P < 0.05, statistically significant.

Figure & Data

References

Citations

Citations to this article as recorded by

Emergency physician ultrasound diagnosis of pneumoperitoneum in intraoperative patients with peritoneal insufflation
Amy Sanghvi, Makoto Tanigawa, Michael Danta, Jeff Yang, Mohammad Hamshow, Errel Khordipour, Lawrence Haines, Leily Naraghi
The American Journal of Emergency Medicine.2025; 90: 120. CrossRef
Prognostic determinants in surgical critial patients undergoing emergency surgery for Stage III or higher colorectal cancer
Hyun Ho Kim, Sanguk Hwang, Jinbeom Cho
Langenbeck's Archives of Surgery.2025;[Epub] CrossRef
In Situ 4D Printing of Polyelectrolyte/Magnetic Composites for Sutureless Gastric Perforation Sealing
Yunsong Shi, Sihan Tang, Xi Yuan, Zhuofan Li, Shifeng Wen, Zhongwei Li, Bin Su, Chunze Yan, Lili Chen
Advanced Materials.2024;[Epub] CrossRef
Small Intestinal Perforation after 360-Degree Liposuction: A Case Report
Jenna C. Bekeny, Samuel S. Huffman, Chris Thomas, Mariana Tumminello, Anna Kata, Rajiv Parikh, Laura K. Tom, Grant M. Kleiber
Aesthetic Plastic Surgery.2024; 48(5): 946. CrossRef
Issues of informed consent for non-specialists conducting colorectal cancer screenings
Forrest Bohler, Allison Garden
Journal of Osteopathic Medicine.2024; 124(1): 39. CrossRef
Prevalence, Pattern, Mortality, and Morbidity of Traumatic Small Bowel Perforation at King Abdulaziz Medical City: A Retrospective Cohort Study
Fahad Aljehaiman, Faisal J Almalki, Abdulah Alhusain, Faris Alsalamah, Khaled Alzahrani, Abdulkareem Alharbi, Hani Alkhulaiwi
Cureus.2024;[Epub] CrossRef
Abdominal pain after a food crawl
Danier Ong, Rajiv Yogendran, Emily Fite
Journal of the American College of Emergency Physicians Open.2024;[Epub] CrossRef
Case of abdominal whirl sign with small bowel obstruction and free gas successfully managed by conservative management instead of laparoscopic surgery
Giuleta Jamsari, James Wei Tatt Toh
Laparoscopic, Endoscopic and Robotic Surgery.2024; 7(3): 128. CrossRef
Emergent Esophagectomy in Patients with Esophageal Malignancy Is Associated with Higher Rates of Perioperative Complications but No Independent Impact on Short-Term Mortality
Yahya Alwatari, Devon C. Freudenberger, Jad Khoraki, Lena Bless, Riley Payne, Walker A. Julliard, Rachit D. Shah, Carlos A. Puig
Journal of Chest Surgery.2024; 57(2): 160. CrossRef
Urea to Albumin Ratio Is an Excellent Predictor of Death in Patients With Complicated Intra-Abdominal Infections
Evgeni Dimitrov, Krasimira Halacheva, Georgi Minkov, Emil Enchev, Yovcho Yovtchev
Surgical Infections.2024; 25(3): 225. CrossRef
Postoperative Complications in Emergency Surgeries at a Referral Hospital in Eastern Venezuela
Victor Castañeda-Marquez, Yeisson Rivero-Moreno, Enrique Avila-Liendo, Gabriel Gonzalez-Quinde, Wilson Garcia-Cazorla, Georcimar Mendez-Meneses, Yoalkris E Salcedo, Tamara Rodriguez-Rugel, Jackner Antigua-Herrera, Miguel Rivas-Perez, Silvia Agudelo-Mendoz
Cureus.2024;[Epub] CrossRef
Gastrointestinal tract perforation after radiofrequency ablation for hepatic tumor: Incidence and risk factors
Kyowon Gu, Tae Wook Kang, Seungchul Han, Dong Ik Cha, Kyoung Doo Song, Min Woo Lee, Hyunchul Rhim, Go Eun Park
European Journal of Radiology.2024; 177: 111560. CrossRef
Revisiting Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) Scores: Are They Valid in Cases of Ileal Perforation?
Saikrishna Eswaravaka, Chirantan Suhrid, Bhavya Rao, Sundaresh Prabhakar, Jayashri Pandya
Cureus.2024;[Epub] CrossRef
A giant trichobezoar in a child with attention deficit hyperactivity disorder: A case report
M. Forooghi, R. Shahrokhi, Sh. Yousufzai
International Journal of Surgery Case Reports.2024; 123: 110283. CrossRef
Factors related to cardiac rupture after acute myocardial infarction
Xue Gao, Ying Guo, Xiaoting Zhu, Chunlei Du, Beibei Ma, Yinghua Cui, Shuai Wang
Frontiers in Cardiovascular Medicine.2024;[Epub] CrossRef
Investigating the association between osteopenia and bowel perforation through a multicenter radiologic analysis
Sebastian Sanduleanu, Koray Ersahin, Jonathan Kottlors, Johannes Bremm, Narmin Talibova, Tim Damer, Merve Erdogan, Nils Groβe Hokamp, Lukas Goertz, Nijat Nasirov, Vilayat Valiyev, Christiane Bruns, David Maintz, Nuran Abdullayev
Scientific Reports.2024;[Epub] CrossRef
Case report: Migratory biliary stent resulting in sigmoid colon perforation
Jasmine B Beloy, Nicholas P Lund, Annika M Van Hell, Shyam Allamaneni
Journal of Surgical Case Reports.2024;[Epub] CrossRef
Prognostic factors in patients with gastrointestinal perforation under the acute care surgery model : a retrospective cohort study
Kiyoung Sung, Sanguk Hwang, Jaeheon Lee, Jinbeom Cho
BMC Surgery.2024;[Epub] CrossRef
Characteristics, treatment, and outcome of patients with bowel perforation after immune checkpoint inhibitor exposure
Antonio Pizuorno Machado, Malek Shatila, Cynthia Liu, Yang Lu, Mehmet Altan, Isabella C. Glitza Oliva, Dan Zhao, Hao Chi Zhang, Anusha Thomas, Yinghong Wang
Journal of Cancer Research and Clinical Oncology.2023; 149(9): 5989. CrossRef
Abdominal emergency surgery in patients with hematological malignancies: a retrospective single-center analysis
Philipp H. von Kroge, Anna Duprée, Oliver Mann, Jakob R. Izbicki, Jonas Wagner, Paymon Ahmadi, Sören Weidemann, Raissa Adjallé, Nicolaus Kröger, Carsten Bokemeyer, Walter Fiedler, Franziska Modemann, Susanne Ghandili
World Journal of Emergency Surgery.2023;[Epub] CrossRef
Acute Spontaneous Colonic Perforation in a Case of Newly Confirmed Scleroderma: Case Report
Glenn Goodwin, Christian Ryckeley, Davide Fox, Michael Ashley, Laurence Dubensky, Mauricio Danckers, Todd Slesinger
Interactive Journal of Medical Research.2023; 12: e43295. CrossRef
Surgical outcomes and prognostic factors associated with emergency left colonic surgery
Dauda Bawa, Yasser Mohammad Khalifa, Saleem Khan, Waddah Norah, Nibras Noman
Annals of Saudi Medicine.2023; 43(2): 97. CrossRef
Fatal Case of Perforated Cytomegalovirus Colitis: Case Report and Systematic Review
Andrea T. Fisher, Kovi E. Bessoff, Veronica Nicholas, James Badger, Lisa Knowlton, Joseph D. Forrester
Surgical Infections.2022; 23(2): 127. CrossRef
An adhesive and resilient hydrogel for the sealing and treatment of gastric perforation
Jing Chen, Julia S. Caserto, Ida Ang, Kaavian Shariati, James Webb, Bo Wang, Xi Wang, Nikolaos Bouklas, Minglin Ma
Bioactive Materials.2022; 14: 52. CrossRef
Predictors of mortality in patients with acute small-bowel perforation transferred to ICU after emergency surgery: a single-centre retrospective cohort study
Jianzhang Wu, Ping Shu, Hongyong He, Haojie Li, Zhaoqing Tang, Yihong Sun, Fenglin Liu
Gastroenterology Report.2022;[Epub] CrossRef
Delayed ileal perforation following lollipop-stick ingestion in a two year old
Tareq Swedan, Mohamed Morjan, Mulham Jarjanazi, Nafiza Martini, Alaa Aldin Ismail, Hebatullah Awad, Shamseh Benbash
Journal of Pediatric Surgery Case Reports.2022; 81: 102276. CrossRef
The Clinical Significance of Shock Index and GFR in the Differential Diagnosis of Perforated Appendicitis
Ferhat ÇAY, Ali DURAN
Journal of Contemporary Medicine.2022; 12(4): 504. CrossRef
The Impact of Delayed Surgical Care on Patient Outcomes With Alimentary Tract Perforation: Insight From a Low-Middle Income Country
Muhammad H Zafar, Taha A Zaka Ur Rehman, Muhammad Sohaib Khan, Shayan Ahmed, Amir Shariff
Cureus.2022;[Epub] CrossRef
Gangrene of the Colon Ascendens, Colon Transversum, and Lienal Flexure in a Massive Strangulated Umbilical Hernia
Stanko Baco, Milos Mitric
Cureus.2022;[Epub] CrossRef
Facility of Origin Predicts Mortality After Colonic Perforation
Samuel D. Butensky, Emma Gazzara, Gainosuke Sugiyama, Gene F. Coppa, Antonio Alfonso, Paul J. Chung
The American Surgeon™.2021; 87(8): 1327. CrossRef
Effect of Malnutrition Assessed by Comprehensive Nutritional Screening Tool on In-Hospital Mortality after Surgery for Gastrointestinal Perforation
Seung-Young Oh, Hannah Lee, Ho Geol Ryu, Hyuk-Joon Lee
Surgical Metabolism and Nutrition.2021; 12(1): 1. CrossRef
Machine Learning-based Model for Predicting Postoperative Complications among Patients with Colonic Perforation: A Retrospective study
Hiroka Hosaka, Masashi Takeuchi, Tomohiro Imoto, Haruka Yagishita, Ayaka Yu, Yusuke Maeda, Yosuke Kobayashi, Yoshie Kadota, Masanori Odaira, Fumiki Toriumi, Takashi Endo, Hirohisa Harada
Journal of the Anus, Rectum and Colon.2021; 5(3): 274. CrossRef
Bevacizumab and gastrointestinal perforations: a review from the FDA Adverse Event Reporting System (FAERS) database
Thomas A. Wichelmann, Sufyan Abdulmujeeb, Eli D. Ehrenpreis
Alimentary Pharmacology & Therapeutics.2021; 54(10): 1290. CrossRef
A Rare Presentation of Gastric Carcinoma With Gastric Perforation and Septic Shock
Reem Moala AlHazmi, Dunya Nasrallah Alfaraj, Shaykhah Nasser AlNaimi, Sarah Mohammed AlQahtani, Mashael Hamed AlJuwayed, Hazem Mohammed Zakriea, Mohammed S Foula
Cureus.2021;[Epub] CrossRef
C-Reactive Protein as a Marker of Postoperative Complication of Emergency Colorectal Surgery
Luis R. M. Nadal, Artur M. A. da Silva, Larissa Johann, Shuaib H. El Boustani, Maria Beatriz A. S. Medrado, Jose F. M. Farah, Renato A. Lupinacci
Journal of Coloproctology.2021; 41(04): 375. CrossRef
Modified frailty index and hypoalbuminemia as predictors of adverse outcomes in older adults presenting to acute general surgical unit
Angela Abraham, Sally Burrows, Neelankal John Abraham, Bhaskar Mandal
Revista Española de Geriatría y Gerontología.2020; 55(2): 70. CrossRef
Prognostic Factors and Management for Left Colonic Perforation: Can Hartmann’s Procedure Be Preventable?
Yilseok Joo, Yujin Lee, Taeyoung Yoo, Jungbin Kim, Inseok Park, Geumhee Gwak, Hyunjin Cho, Keunho Yang, Kiwhan Kim, Byung-Noe Bae
Annals of Coloproctology.2020; 36(3): 178. CrossRef
Intestinal Perforation: A Surgeon's Nightmare Enlightened by Scientific Research
Byung Soh Min
Annals of Coloproctology.2016; 32(6): 205. CrossRef

PubReader

Cite this Article

Cite this Article: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation

Ann Coloproctol. 2016;32(6):221-227. Published online December 31, 2016

DOI: https://doi.org/10.3393/ac.2016.32.6.221

XML Download

Figure

Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation

Fig. 1 Surgical methods used to treat patients with intestinal perforations (n = 117). R&A, resection and anastomosis.

Fig. 2 Kaplan-Meier analysis of 30-day mortality in patients with feculent ascites and nonfeculent ascites after surgery for an intestinal perforation. A log-rank test indicated significantly greater mortality in patients with feculent ascites.

Fig. 3 Incidences and mortality rates of postoperative complications after surgery for an intestinal perforation.

Fig. 1

Fig. 2

Fig. 3

Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation

Table 1

Etiology of the intestinal perforation in the study population (n = 117)

Table 2

Univariate analysis of patient-related and operation-related factors associated with mortality within one month after surgery for an intestinal perforation

Values are presented as mean ± standard deviation or number (%) unless otherwise indicated.

eGFR, estimated glomerular filtration rate; PT INR, prothrombin time international normalized ratio; aPTT, activated partial thromboplastin time; R&A, resection and anastomosis.

^*P < 0.05, statistically significant.

Table 3

Multivariable analysis of factors associated with mortality within one month after surgery for an intestinal perforation

OR, odds ratio; CI, confidence interval; sBP, systolic blood pressure.

^*P < 0.05, statistically significant.

Table 4

Univariate analysis of patient-related and surgery-related factors associated with postoperative complications within 1 month after surgery for an intestinal perforation^a

Values are presented as number (%).

eGFR, estimated glomerular filtration rate.

^aComplications are in Fig. 3. ^*P < 0.05, statistically significant.

Table 5

Multivariable analysis of factors associated with postoperative complications within one month after an intestinal perforation

OR, odds ratio; CI, confidence interval; eGFR, estimated glomerular filtration rate; CRP, C-reactive protein.

^*P < 0.05, statistically significant.

Table 1 Etiology of the intestinal perforation in the study population (n = 117)

Table 2 Univariate analysis of patient-related and operation-related factors associated with mortality within one month after surgery for an intestinal perforation

Values are presented as mean ± standard deviation or number (%) unless otherwise indicated.

eGFR, estimated glomerular filtration rate; PT INR, prothrombin time international normalized ratio; aPTT, activated partial thromboplastin time; R&A, resection and anastomosis.

^*P < 0.05, statistically significant.

Table 3 Multivariable analysis of factors associated with mortality within one month after surgery for an intestinal perforation

OR, odds ratio; CI, confidence interval; sBP, systolic blood pressure.

^*P < 0.05, statistically significant.

Table 4 Univariate analysis of patient-related and surgery-related factors associated with postoperative complications within 1 month after surgery for an intestinal perforationa

Values are presented as number (%).

eGFR, estimated glomerular filtration rate.

^aComplications are in Fig. 3. ^*P < 0.05, statistically significant.

Table 5 Multivariable analysis of factors associated with postoperative complications within one month after an intestinal perforation

OR, odds ratio; CI, confidence interval; eGFR, estimated glomerular filtration rate; CRP, C-reactive protein.