Prognostic Factors and Postoperative Complications in Patients with Colorectal Perforation

Shohken Chin¹⁾²⁾, Ryoichi Fujita¹⁾, Yoshitetsu Kawa¹⁾, Mamiko Ubukata¹⁾²⁾, Yusuke Tada¹⁾, Jun Murata¹⁾ and Shingo Kameoka²⁾

Department of Surgery, Asakadai Central General Hospital¹⁾
Department of Surgery II, Tokyo Women's Medical University, School of Medicine²⁾

Purpose: To improve prognosis, we evaluated preoperative factors for treating colorectal perforation and potentially fatal factors and postoperative complications. Methods: Subjects were 35 persons undergoing emergency surgery for colorectal perforation between January 2004 and August 2008. We analyzed preoperative factors of age, complications, perforation cause and site, white blood cell count, creatinine, prothrombin time, base excess, body temperature, blood pressure, APACHE II score, time from perforation onset to surgical intervention, ascites, and surgical procedure. We then analyzed potentially fatal postoperative complications for mortality. Results: Overall mortality was 23% (N=8) for which significant predictive factors in univariate analysis were creatinine, prothrombin time, base excess, body temperature, blood pressure, APACHE II score, and ascites. Multivariate logistic regression analysis, however, showed only the APACHE II score to be significantly associated with mortality (relative risk 1.89, p=0.005). Mortality in those with an APACHE II score of ≥20 was 83%, compared to 10%, in those with an APACHE II score of <20 (p=0.001). Postoperative mortality increased significantly from zero in those without the postoperative infection such as intraperitoneal infection, bacteremia or pneumonia to 53% in those with the infections (p<0.001). Mortality increased significantly from 13% in those without disseminated intravascular coagulation (DIC) to 80% in those with it (p=0.006). Conclusions: The APACHE II score is significantly predictive in those with colorectal perforation. And, it indicated that successful management of the postoperative infections could reduce mortality.

Key words
colorectal perforation, APACHE II score, intraperitoneal infection, bacteremia, DIC

Reprint requests
Shohken Chin Department of Surgery, Asakadai Central General Hospital
1-8-10 Nishibenzai, Asaka, 351-8551 JAPAN

Accepted
February 17, 2010

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