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Urgent and Emergent Colectomy: Indications, Outcomes and Predictors of Reoperation and Death in 507 Patients
*Raisa R. Gao DO1, *Nicholas Stevens DO1, *Kayla Flewelling MD1, *Clayton Wyland DO1, *Austin Brubaker MS2, *Theresa McGoff MBA, RN, CCRP2, Laurence McCahill MD1
1General Surgery, Western Michigan University School of Medicine, Kalamazoo, MI; 2Department of Biomedical Informatics, Western Michigan University School of Medicine, Kalamazoo, MI

Background: We previously reported a high reoperation rate (12.4%) and death rate (10.4%) after Urgent or Emergent (U/E) colectomy across 72 hospitals of the Michigan Surgery Quality Collaborative (MSQC). To better understand these results, we conducted a review of cases performed at our institution for which clinical details (not available in the MSQC dataset) were recorded. We sought to better characterize indications for surgery, reoperation and factors contributing to reoperation and postoperative mortality.
Methods: Retrospective study of patients undergoing U/E colectomy at a single institution from 2013 to 2023. Indications for index surgery and reoperation, procedures performed and outcomes were captured. Logistic regression analysis was used to identify factors associated with reoperation and mortality.
Results: 507 patients met criteria, mean age was 63, M:F ratio 44:56, Ethnicity (White:Other) 87:13. Emergent cases made up 41% and reoperation occurred in 23.1%. Most common indications for index surgery in the reoperation (RO)/non-reoperation (NRO) groups were diverticulitis (32% and 30%) and cancer (19% and 33%). Ischemic bowel (13.7%) and colonic pseudo-obstruction (6.8%) were more common in the RO group compared to colon volvulus (10.4%) and IBD (4.7%) in the NRO group. Most common procedures performed at index operation were sigmoidectomy (35.9% and 35.0%), subtotal colectomy (18.0% and 8.9%), right colectomy (17.1% and 22.7%) and ileocectomy (8.6% and 8.8%). Most common procedures performed at reoperation were abdominal washout (61.5%), abdominal closure (41%), anastomosis/anastomotic revision (22.2%) and ostomy creation (20.5%). Risk factors predictive of reoperation include: ASA class, preoperative acute kidney injury (AKI), higher than average preoperative WBC, intraoperative pressor use, higher wound contamination class and emergent case status. Risk factors predictive of 90-day mortality included: older age, non-independent functional status, ASA class, AKI, higher leukocytosis, lower albumin, sepsis at time of surgery, higher wound contamination classification, intraoperative pressor support and blood transfusion. Postoperative complications were notably high, and patterns were different between RO and NRO groups (See Table 1). Mean CCI was significantly higher in the RO (56.2 vs 21.7, p <0.0001).RO group had a longer mean LOS (19.7 vs. 10.1 days, p<.0001), were less frequently discharged to home (46.2% vs 73.1%, p<0.0001), had a higher 30-day readmission rate (27.4% vs 16.6%, p= 0.0098), and higher 90-day mortality rate (19.0% vs 11.7%, p= 0.043).
Conclusion: We identified significant differences in the indications and outcomes between RO and NRO groups for patients undergoing U/E colectomy. We also identified both preoperative and intraoperative risk factors associated with postoperative mortality and reoperation. These findings may be useful in caring for U/E colectomy patients with extraordinary morbidity and mortality.


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