Prediction of mortality in patients with colorectal perforation based on routinely available parameters: a retrospective study

Abstract

Introduction: Even after surgery and intensive postoperative management, the mortality rate associated with colorectal perforation is high. Identification of mortality markers using routinely available preoperative parameters is important.

Methods: We enrolled consecutive patients with colorectal perforation who underwent operations from January 2010 to January 2015. We divided them into a mortality and survivor group and compared clinical characteristics between the two groups. Additionally, we compared the mortality rate between different etiologies: malignant versus benign and diverticular versus nondiverticular. We used the χ (2) and Mann-Whitney U tests and a logistic regression model to identify factors associated with mortality.

Results: We enrolled 108 patients, and 52 (48 %) were male. The mean age at surgery was 71 ± 13 years. The postoperative mortality rate was 12 % (13 patients). Multivariate logistic regression analysis showed that a high patient age (odds ratio [OR], 1.09; 95 % confidence interval [CI], 1.020-1.181) and low preoperative systolic blood pressure (OR, 0.98; 95 % CI, 0.953-0.999) were independent risk factors for mortality in patients with colorectal perforation. In the subgroup analysis, there was no significant difference between the malignant and benign group (11.8 % vs. 23.9 %, respectively; p = 0.970), while the diverticular group had a significantly lower mortality rate than the nondiverticular group (2.6 % vs. 17.1 %, respectively; p = 0.027).

Conclusions: Older patients and patients with low preoperative blood pressure had a high risk of mortality associated with colorectal perforation. For such patients, operations and postoperative management should be performed carefully.

Keywords: Colorectal perforation; Mortality marker; Prognostic factor.

Fig. 1

Patient selection

Fig. 2

Comparison of age between mortality group and survivor group. Patients were significantly older in the mortality group than in the survivor group (79 ± 8 vs. 70 ± 13 years, respectively; p = 0.008)

Fig. 3

Comparison of preoperative systolic blood pressure between mortality group and survivor group. Preoperative systolic blood pressure was significantly lower in the mortality group than in the survivor group (96 vs. 130 mmHg, respectively; p = 0.039)

Fig. 4

Comparison of mortality rate between malignant group and benign group. There was no significant difference in the mortality rate between the two groups (11.8 % vs. 23.9 %, respectively; p = 0.970)

Fig. 5

Comparison of mortality rate between diverticular group and nondiverticular group. The mortality rate of the diverticular group was significantly lower than that of the nondiverticular group (2.6 % vs. 17.1 %, respectively; p = 0.027)