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Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation

대한대장항문학회지 2016년 32권 6호 p.221 ~ 227
 ( Shin Ru-Mi ) - SMG-SNU Boramae Medical Center Department of Surgery

 ( Lee Sang-Mok ) - SMG-SNU Boramae Medical Center Department of Surgery
 ( Sohn Beong-Hoon ) - SMG-SNU Boramae Medical Center Department of Surgery
 ( Lee Dong-Woon ) - Seoul National University College of Medicine Department of Surgery
 ( Song In-Ho ) - Seoul National University College of Medicine Department of Surgery
 ( Chai Young-Jun ) - SMG-SNU Boramae Medical Center Department of Surgery
 ( Lee Hae-Won ) - SMG-SNU Boramae Medical Center Department of Surgery
 ( Ahn Hye-Seong ) - SMG-SNU Boramae Medical Center Department of Surgery
 ( Jung In-Mok ) - SMG-SNU Boramae Medical Center Department of Surgery
 ( Chung Jung-Kee ) - SMG-SNU Boramae Medical Center Department of Surgery
 ( Heo Seung-Chul ) - SMG-SNU Boramae Medical Center Department of Surgery

Abstract


Purpose: An intestinal perforation is a rare condition, but has a high mortality rate, even after immediate surgical intervention. The clinical predictors of postoperative morbidity and mortality are still not well established, so this study attempted to identify risk factors for postoperative morbidity and mortality after surgery for an intestinal perforation.

Methods: We retrospectively analyzed the cases of 117 patients who underwent surgery for an intestinal perforation at a single institution in Korea from November 2008 to June 2014. Factors related with postoperative mortality at 1 month and other postoperative complications were investigated.

Results: The mean age of enrolled patients was 66.0 ± 15.8 years and 66% of the patients were male. Fifteen patients (13%) died within 1 month after surgical treatment. Univariate analysis indicated that patient-related factors associated with mortality were low systolic and diastolic blood pressure, low serum albumin, low serum protein, low total cholesterol, and high blood urea nitrogen; the surgery-related factor associated with mortality was feculent ascites. Multivariate analysis using a logistic regression indicated that low systolic blood pressure and feculent ascites independently increased the risk for mortality; postoperative complications were more likely in both females and those with low estimated glomerular filtration rates and elevated serum C-reactive protein levels.

Conclusion: Various factors were associated with postoperative clinical outcomes of patients with an intestinal perforation. Morbidity and mortality following an intestinal perforation were greater in patients with unstable initial vital signs, poor nutritional status, and feculent ascites.

키워드

Intestinal perforations; Postoperative mortality; Postoperative complications; Ascites
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