Mortality after acute surgery for complications of diverticular disease of the sigmoid colon is almost exclusively due to patient related factors
- 1 July 2005
- journal article
- Published by Wiley in Colorectal Disease
- Vol. 8 (2), 112-119
- https://doi.org/10.1111/j.1463-1318.2005.00848.x
Abstract
Auditing the outcome of surgery for complicated diverticulitis of the sigmoid colon is difficult. A comparison of studies is hardly possible because risk factors both in terms of the severity of diverticulitis and patient-related risk factors are neither well described nor standardized. The purpose of this study was to define morbidity and mortality of primary surgery for acute complications of diverticular disease of the sigmoid colon and to identify the relation between risk factors and morbidity and mortality. In a prospective computerized morbidity and mortality registration from 1990 to 2002, 114 patients, who underwent surgery on an acute or urgent base for acute complications of diverticular disease of the sigmoid colon, were identified. In all patients the POSSUM score was calculated. To audit mortality rates a POSSUM based scoring system was introduced. Mortality was 16.7%, and morbidity 71.1%. Higher morbidity rates were significantly related to a higher POSSUM physiological score (P = 0.012) and to older age (P < 0.001). Higher mortality rates also were significantly related to a higher POSSUM physiological score (P < 0.001) and older age (P = 0.003). Patients who died had significantly more sepsis (P < 0.001), multiple organ failure (P = 0.027), cardiac (P < 0.001) and pulmonary (P = 0.013) complications. Gender, operation indication and type of neither surgery nor surgeon had a significant relation with morbidity or mortality. Surgery for acute complications of diverticular disease of the sigmoid colon carries a high morbidity rate and a substantial mortality rate. The majority of deceased patients had severe comorbidity. Post-operative mortality and morbidity are to a large extent driven by patient related factors. Elevated physiological severity scores and a lack of peri-operative management failures express this in the majority of deceased patients.Keywords
This publication has 40 references indexed in Scilit:
- POSSUM and P-POSSUM for risk-adjusted audit of patients undergoing emergency laparotomyBritish Journal of Surgery, 2004
- Validation of POSSUM scoring systems for audit of major hepatectomyBritish Journal of Surgery, 2004
- The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM)British Journal of Surgery, 2003
- Evaluation of POSSUM and P-POSSUM scoring systems in patients undergoing colorectal surgeryBritish Journal of Surgery, 2003
- Evaluation of POSSUM in patients with oesophageal cancer undergoing resectionBritish Journal of Surgery, 2002
- Differences in clinical performanceBritish Journal of Surgery, 2002
- Five-year audit of the acute complications of diverticular diseaseBritish Journal of Surgery, 1997
- The Quality of CareJAMA, 1988
- The quality of care. How can it be assessed?JAMA, 1988
- Changing Patterns in the Surgical Treatment of Diverticular DiseaseAnnals of Surgery, 1984