Factors associated with 30-day mortality and morbidity in patients undergoing emergency colorectal surgery

BACKGROUND: The 30-day period following emergency colorectal surgery (ECRS) is associated with high mortality and morbidity. There is a lack of data assessing factors associated with outcomes of ECRS in the Saudi population. OBJECTIVES: Assess factors associated with 30-day postoperative mortality and complications following ECRS DESIGN: Retrospective cohort study SETTING: Single tertiary care center, Riyadh, Saudi Arabia PATIENTS AND METHODS: Demographic characteristics (age, sex, diagnosis, American Society of Anesthesiologists classification, pre-operative septic state, smoking, and comorbidities), operative char-acteristics (urgency, diverting ostomy, and procedure performed), and postoperative characteristics (length of stay, 30-day mortality, intensive care unit [ICU] admission, ICU length of stay, surgical site infection [SSI], readmission, reoperation, and complications) were col-lected from electronic medical records. Univariate logistic regression was used to evaluate association with the outcome measures (30-day mortality and postoperative complications). Multivariate logistic re-gression was applied to evaluate independent variables. MAIN OUTCOME MEASURE: Thirty-day postoperative mortality and morbidity SAMPLE SIZE: 241 patients RESULTS: Among 241 patients, 145 (60.2%) were men, and 80 (33.2%) patients were between 50-64 years of age. The most common indica-tion for surgery was malignancy 138 (57%). The overall complication rate was 26.6% and the 30-day mortality rate was 11.2%. Left hemi-colectomy was the most commonly performed procedure, performed in 69 (28.6%) patients. Patients between the age of 65-74 had an in-creased odds of death within 30 days (OR 5.25 [95% CI 1.03-26.5]) on univariate analysis. Preoperative sepsis was associated with a fourfold increase in the likelihood of 30-day mortality (OR 4.44, 95% CI 1.21-16.24, P=.024) on multivariate analysis. The likelihood of hospital re-admission increased by fivefold in patients who developed a postop-erative complication (OR 5.33, 95% CI 1.30-21.78, P=.02). CONCLUSION: Preoperative sepsis was independently associated with 30-day mortality in patients undergoing ECRS, while the likeli-hood of hospital readmission increased in patients with postoperative complications. Expeditious control of sepsis in the emergency surgical setting by both surgical and medical interventions may reduce the like-lihood of postoperative mortality. Establishing discharge protocols for postoperative ECRS patients is advocated. LIMITATIONS: Retrospective design, small sample size, and single setting