M. Baldawi1, M. Baldawi1, M. Al-Jubouri1, M. Osman1, J. Ortiz1, F. C. Brunicardi1, M. Nazzal1 1University Of Toledo Medical Center,Department Of Surgery,Toledo, OH, USA
Introduction: Ischemic colitis is an injury to the colon as a result of reduced blood flow. It ranges from mild inflammation that mandates medical treatment to full thickness necrosis requiring surgical intervention. The aim of our study is to determine the impact of delay of surgical intervention on postoperative morbidity and mortality among surgically managed patients with ischemic colitis.
Methods: A retrospective cohort study of ischemic colitis patients who underwent colorectal resection was performed. Patients were selected by ICD9/ICD10 codes of ischemic colitis and CPT codes of colorectal resection from the American College of Surgeons National Surgical Quality and Improvement Program (ACS NSQIP) database for the time period between 2011 to 2016. Patients were then classified according to the time interval between admission and surgical intervention (No delay, 1-day delay and ≥2 days delay), and these groups were compared for the rate of 30-day postoperative complications. Univariate analysis was performed using Chi-square and ANOVA tests while a binary logistic regression and Analysis of Covariance (ANCOVA) tests were utilized in the multivariate analysis.
Results: Of 3,726 patients, 1,681 (45.1%) underwent surgery at the day of admission, 839 (22.5%) underwent surgery 1 day after admission and 1,206 (32.4%) underwent surgery ≥2 days after admission. In comparison to No delay group, 1-day and ≥2 days delay groups had higher rates of 30-day mortality (26.7% and 26.2% vs 19.1%, p<0.001), pneumonia (13.7% and 14.9% vs 10.7%, p<0.001), unplanned intubation (12% and 10% vs 8.6%, p=0.021), mechanical ventilation >48 hours (34% and 34.9% vs 26.6%, p<0.001), acute kidney injury (8.5% and 5.8% vs 3.7%, p<0.001), UTI (4.4% and 5% vs 2.9%. P=0.01), blood transfusion (38.9% and 45.8% vs 30.5%, p<0.001) and DVT (3.7% and 3.8% vs 2%, p=0.008). Multivariate analysis confirms delay of surgery as an independent predictor of 30-day mortality, pneumonia, mechanical ventilation >48 hours, acute kidney injury, UTI, blood transfusion and DVT (p<0.05). ANCOVA with multiple pairwise comparison test revealed an increase in average postoperative stay with increase in delay of surgery (11.4 days in No delay, 12.7 days in 1-day delay and 14.7 days in ≥2 days delay, p<0.05).
Conclusion: Delay of colorectal resection in patients with ischemic colitis leads to higher complications including pneumonia, prolonged mechanical ventilation, acute kidney injury, UTI, blood transfusion, DVT, postoperative length of stay and death.