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Outcomes and predictors of mortality and stoma formation in surgical management of colonoscopic perforations: a multicenter review.
Arch Surg. 2009 Jan; 144(1):9-13.AS

Abstract

OBJECTIVES

To perform a retrospective review of all patients with colonoscopic perforations managed in hospitals within the Eastern New Territories region of Hong Kong and to determine the predictors of mortality and stoma formation in patients with colonoscopic perforations.

DESIGN

Retrospective computer-based review.

SETTING

Multicenter (1 university teaching hospital and 2 district hospitals).

METHODS

We reviewed the outcomes of patients with colonoscopic perforations surgically managed between January 1, 1998, and December 31, 2005. Predictors of mortality and stoma formation were identified with multivariable analysis.

MAIN OUTCOME MEASURES

Mortality and stoma rates and their predictors.

RESULTS

A total of 37,971 colonoscopies were performed during the study period, and 43 colonoscopic perforations were identified. The overall perforation rate was 0.113% and represented a decreasing trend. There was no significant difference in the perforation rate between gastroenterologists (0.148%) and surgeons (0.091%) (P = .15). Perforations that occurred during diagnostic colonoscopies were significantly larger than those that occurred during therapeutic colonoscopies (P = .04), and the patients presented earlier (P = .02). Surgical intervention was performed in 39 patients. The overall morbidity and mortality rate was 48.7% and 25.6%, respectively. The stoma rate was 38.5%. The predictors of stoma formation include moderate to severe peritoneal contamination and the presence of malignant colonic neoplasms (P = .01 and P = .008, respectively). The predictors of mortality include American Society of Anesthesiologists class 3 or higher and antiplatelet therapy (P = .009 and P = .001, respectively).

CONCLUSIONS

Colonoscopic perforations were in a decreasing trend. Patients with predictors of mortality should not be treated conservatively. Other options of large bowel investigations should be considered in high-risk patients when the potential diagnostic yield is low.

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Authors+Show Affiliations

Teoh AY
Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China. anthonyteoh@surgery.cuhk.edu.hk
Poon CM
No affiliation info available
Lee JF
No affiliation info available
Leong HT
No affiliation info available
Ng SS
No affiliation info available
Sung JJ
No affiliation info available
Lau JY
No affiliation info available

MeSH

AdolescentAdultAgedAged, 80 and overColonColonoscopyFemaleHumansIntestinal PerforationMaleMiddle AgedPrognosisRetrospective StudiesSurgical StomasTreatment OutcomeYoung Adult

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

19153318

Citation

Teoh, Anthony Yuen Bun, et al. "Outcomes and Predictors of Mortality and Stoma Formation in Surgical Management of Colonoscopic Perforations: a Multicenter Review." Archives of Surgery (Chicago, Ill. : 1960), vol. 144, no. 1, 2009, pp. 9-13.
Teoh AY, Poon CM, Lee JF, et al. Outcomes and predictors of mortality and stoma formation in surgical management of colonoscopic perforations: a multicenter review. Arch Surg. 2009;144(1):9-13.
Teoh, A. Y., Poon, C. M., Lee, J. F., Leong, H. T., Ng, S. S., Sung, J. J., & Lau, J. Y. (2009). Outcomes and predictors of mortality and stoma formation in surgical management of colonoscopic perforations: a multicenter review. Archives of Surgery (Chicago, Ill. : 1960), 144(1), 9-13. https://doi.org/10.1001/archsurg.2008.503
Teoh AY, et al. Outcomes and Predictors of Mortality and Stoma Formation in Surgical Management of Colonoscopic Perforations: a Multicenter Review. Arch Surg. 2009;144(1):9-13. PubMed PMID: 19153318.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes and predictors of mortality and stoma formation in surgical management of colonoscopic perforations: a multicenter review. AU - Teoh,Anthony Yuen Bun, AU - Poon,Chi Ming, AU - Lee,Janet Fung Yee, AU - Leong,Hing Tat, AU - Ng,Simon Siu Man, AU - Sung,Joseph Jao Yiu, AU - Lau,James Yun Wong, PY - 2009/1/21/entrez PY - 2009/1/21/pubmed PY - 2009/2/12/medline SP - 9 EP - 13 JF - Archives of surgery (Chicago, Ill. : 1960) JO - Arch Surg VL - 144 IS - 1 N2 - OBJECTIVES: To perform a retrospective review of all patients with colonoscopic perforations managed in hospitals within the Eastern New Territories region of Hong Kong and to determine the predictors of mortality and stoma formation in patients with colonoscopic perforations. DESIGN: Retrospective computer-based review. SETTING: Multicenter (1 university teaching hospital and 2 district hospitals). METHODS: We reviewed the outcomes of patients with colonoscopic perforations surgically managed between January 1, 1998, and December 31, 2005. Predictors of mortality and stoma formation were identified with multivariable analysis. MAIN OUTCOME MEASURES: Mortality and stoma rates and their predictors. RESULTS: A total of 37,971 colonoscopies were performed during the study period, and 43 colonoscopic perforations were identified. The overall perforation rate was 0.113% and represented a decreasing trend. There was no significant difference in the perforation rate between gastroenterologists (0.148%) and surgeons (0.091%) (P = .15). Perforations that occurred during diagnostic colonoscopies were significantly larger than those that occurred during therapeutic colonoscopies (P = .04), and the patients presented earlier (P = .02). Surgical intervention was performed in 39 patients. The overall morbidity and mortality rate was 48.7% and 25.6%, respectively. The stoma rate was 38.5%. The predictors of stoma formation include moderate to severe peritoneal contamination and the presence of malignant colonic neoplasms (P = .01 and P = .008, respectively). The predictors of mortality include American Society of Anesthesiologists class 3 or higher and antiplatelet therapy (P = .009 and P = .001, respectively). CONCLUSIONS: Colonoscopic perforations were in a decreasing trend. Patients with predictors of mortality should not be treated conservatively. Other options of large bowel investigations should be considered in high-risk patients when the potential diagnostic yield is low. SN - 1538-3644 UR - https://www.unboundmedicine.com/medline/citation/19153318/Outcomes_and_predictors_of_mortality_and_stoma_formation_in_surgical_management_of_colonoscopic_perforations:_a_multicenter_review_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/archsurg.2008.503 DB - PRIME DP - Unbound Medicine ER -