Survival after operations for ischaemic bowel disease

Abstract

Objective: To find out what factors influence the outcome of operations for ischaemic bowel disease.

Design: Retrospective study.

Setting: University hospital, Sweden.

Main outcome measures: Morbidity and mortality.

Subjects: 74 patients, mean age 75 years (range 40-98), operated on for acute bowel ischaemia between 1987 and 1996.

Results: A total of 75 emergency operations were done, including 42 bowel-resections, one percutaneous transluminal angioplasty, and one thrombectomy. Thirty-one patients had exploration alone because of extensive gangrene. These explorations were performed in 11 of 14 (79%) patients aged >84 years; 18 of 40 (45%) patients aged 71-84 years and 2 of 21 (9%) patients aged <71 years, (p < 0.001). Of the 14 patients over 84 years old only one survived more than 30 days, compared with 12 of 40 (30%) aged 71-84 years, and 17 of 21 (81%) younger than 71 years (p < 0.001). Operation within 6 hours of admission resulted in significantly better survival compared with operations done after more than 6 hours delay (p = 0.04).

Conclusions: Advanced age was a strong risk factor for death after operation for ischaemic bowel disease, and there was a higher incidence of unresectable gangrene. Delay in surgical intervention was associated with increasing mortality.