Ischemic colitis: risk factors for eventual surgery

• Published in: The American journal of surgery Vol. 200; no. 5; pp. 646 - 650
• Main Authors: Paterno, Flavio, M.D, McGillicuddy, Edward A., M.D, Schuster, Kevin M., M.D, Longo, Walter E., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2010; Elsevier; Elsevier Limited
• Subjects: Abdomen; Acute coronary syndromes; Aged; Biological and medical sciences; Bleeding; Bowel ischemia; Cardiovascular disease; Classification; Colitis; Colitis, Ischemic - diagnosis; Colitis, Ischemic - epidemiology; Colitis, Ischemic - surgery; Colon; Colon ischemia; Colonoscopy; Computation; Computed tomography; Connecticut - epidemiology; Coronary vessels; Decision Making; Digestive System Surgical Procedures; Endoscopy; Epidemiology; Female; Fibrillation; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; Hypotension; Incidence; Inflammatory bowel disease; Intervention; Intraoperative Complications - epidemiology; Ischemia; Ischemic colitis; Laboratories; Lactic acid; Male; Mechanical ventilation; Medical imaging; Medical prognosis; Medical sciences; Mortality; Multivariate analysis; Other diseases. Semiology; Patients; Postoperative Complications - epidemiology; Public health. Hygiene; Public health. Hygiene-occupational medicine; Rectum; Retrospective Studies; Risk analysis; Risk Factors; Risk management; Statistical analysis; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery; Tachycardia; Tomography, X-Ray Computed; Treatment Outcome; Ventilation; Ventilators; Connecticut; Bowel ischemia; Colitis; Colon ischemia; Ischemic colitis; Medicine; Treatment; Surgery; Risk factor; Intestinal ischemia; Digestive diseases; Intestinal disease; Epidemiology
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2010.07.005

Abstract Background Ischemic colitis is a common disorder often without clear indications for surgical management. The aim of this study was to identify risk factors that predict the need for surgery. Methods Patients were identified retrospectively based on International Classification of Disease codes and admission over an 8-year period. Results A total of 253 patients presented with ischemic colitis. A total of 205 patients were managed nonsurgically, 12 underwent immediate surgery (within 12 hours of presentation), and 36 had delayed surgery. On univariate analysis, risk factors that predicted delayed surgery were peripheral vascular disease, atrial fibrillation, hypotension, tachycardia, absence of bleeding per rectum, free intraperitoneal fluid on computed tomography scan, intensive care unit admission, vasopressors, mechanical ventilation, and increased lactate level on admission. Intraperitoneal fluid on computed tomography scan and absence of bleeding per rectum were predictive of surgical intervention on multivariate analysis. Conclusions In patients with ischemic colitis, several risk factors were associated with the need for subsequent surgery during the same admission. These factors could be used to select patients for immediate surgery before worsening of their clinical condition.