Current outcomes of emergency large bowel surgery

• Published in: Annals of the Royal College of Surgeons of England Vol. 97; no. 2; pp. 151 - 156
• Main Authors: Ng, H J, Yule, M, Twoon, M, Binnie, N R, Aly, E H
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-03-2015; Royal College of Surgeons
• Subjects: Adult; Aged; Aged, 80 and over; Audits; Colorectal cancer; Colorectal Neoplasms - epidemiology; Colorectal Surgery; Digestive System Surgical Procedures - statistics & numerical data; Emergencies; Female; Fistula; Hospital Mortality; Hospitals; Humans; Intensive Care Units; Intestinal Obstruction - epidemiology; Intestinal Obstruction - surgery; Intestinal Perforation - epidemiology; Intestinal Perforation - surgery; Intestine, Large - surgery; Ischemia - mortality; Male; Medical prognosis; Middle Aged; Morbidity; Mortality; Multiple Organ Failure - mortality; Ostomy; Patient Admission - statistics & numerical data; Patients; Peritonitis - mortality; Postoperative Complications; Retrospective Studies; Surgeons; Surgery; United Kingdom - epidemiology; Young Adult; United Kingdom > UK; Ireland
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/003588414X14055925059679

Emergency large bowel surgery (ELBS) is known to carry an increased risk of morbidity and mortality. Previous studies have reported morbidity and mortality rates up to 14.3%. However, there has not been a recent study to document the outcomes of ELBS following several major changes in surgical training and provision of emergency surgery. The aim of this study was therefore to explore the current outcomes of ELBS.
A retrospective review was performed of a prospectively maintained database of the clinical records of all patients who had ELBS between 2006 and 2013. Data pertaining to patient demographics, ASA (American Society of Anesthesiologists) grade, diagnosis, surgical procedure performed, grade of operating surgeon and assistant, length of hospital stay, postoperative complications and in-hospital mortality were analysed.
A total of 202 patients underwent ELBS during the study period. The mean patient age was 62 years and the most common cause was colonic carcinoma (n=67, 33%). There were 32 patients (15.8%) who presented with obstruction and 64 (31.7%) had bowel perforation. The overall in-hospital mortality rate was 14.8% (n=30). A consultant surgeon was involved in 187 cases (92.6%) as either first operator, assistant or available in theatre.
ELBS continues to carry a high risk despite several major changes in the provision of emergency surgery. Further developments are needed to improve postoperative outcomes in these patients.