Perioperative morbidity and mortality after emergency and elective colon and proximal rectal surgery in Ibadan

Abstract

Objectives: While the epidemiology of benign colonic pathologies has not significantly changed in our region, colorectal cancer has steadily increased with a majority of patients presenting with late stage disease particularly large bowel obstruction. This study reviews the outcome of emergency and elective colon and proximal rectal cases with regards to perioperative morbidity and mortality.
Setting: All patients who had surgery for symptoms of lower gastrointestinal tract disease (caecum and proximal rectum) between January 2008 and January 2018 at University College Hospital, Ibadan were included. Data regarding elective or emergency presentation, peri-operative findings, operative details and postoperative course were recorded prospectively.

Results: Out of the 1618 patients with symptoms, 817 were operated on as emergencies (38.1%) and electives (61.9%). The median age  of patients who had emergency and elective surgery were 56 (33-81) and 59 (27-87) respectively (p-0.05). Right hemicolectomy (152; 18.6%) was the commonest procedure, followed by anterior resection (115; 14.1%) and colostomy (114; 13.9%). Overall morbidity  was 13.7% (elective 4.2%; emergency 9.5%), while mortality was 6.8% (elective 2.1%; emergency 4.7%). The commonest morbidities  were superficial surgical site infection (SSSI) and wound dehiscence. Bowel perforation or gangrene was the most significant predictor of mortality.

Conclusion: Large bowel obstruction complicated with perforation and gangrene is a major risk factor for morbidity and mortality in  colorectal surgery