AIPMED

ANNALS OF IBADAN POSTGRADUATE MEDICINE

PERIOPERATIVE MORBIDITY AND MORTALITY AFTER EMERGENCY AND ELECTIVE COLON AND PROXIMAL RECTAL SURGERY IN IBADAN

O.O. Ayandipo1, 2, O.O. Afuwape1,2, A.B. Ojo2 , I.K. Egbuchulem2 and D.O. Irabor1,2

  1. Department of Surgery, College of Medicine, University of Ibadan, Nigeria.
  2. Department of Surgery, University College Hospital, Ibadan, Nigeria.

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.

Correspondence

Dr. O.O. Ayandipo

Department of Surgery,

University College Hospital,

Ibadan,

Nigeria

Email:yokebukola@yahoo.com


INTRODUCTION

Colorectal cancer has steadily increased in sub-Saharan Africa over the last 20 years1-4, with about two - fifth of patients presenting with late stage disease4,5. One of the commonest modes of presentation of advanced disease are symptoms of large bowel obstruction necessitating emergency treatment, which often leads to an increased morbidity and mortality6 . The epidemiology of benign colonic pathologies has not changed significantly over time in our region; except for the noted reduction in colonic intussusception and sigmoid volvulus which hitherto accounted for a large volume of emergency colon surgeries 7-11. The outcomes following emergency and elective colorectal surgeries have been well studied with documented morbidity and mortality rates of between 1-30% 12-15 . We prospectively reviewed all colon and proximal-rectal surgical cases done since 2008 with the aims of auditing our outcomes with regards to perioperative morbidity and mortality. We also identified risk factors for peri-operative (in-hospital) mortality following colon and proximal rectal surgery in our practice.