TOTAL ABDOMINAL COLECTOMY - CONDITIONS DEFINING OUTCOME

Published conclusions that total abdominal colectomy is a safe procedu re need to be qualified by analysis of specific risk groups. We review ed the records of 87 consecutive patients undergoing total abdominal c olectomy at our institution to determine the factors affecting morbidi ty and mortality. Underlying disease and urgency of operation were the primary determinants of outcome. Mortality was 5.9 per cent in the pa tient groups who had the procedure done non-emergently or for bleeding when transfusion requirements were less than 10 units. Mortality was 10-fold higher (55.6%) in the groups where the procedure was done eith er as an emergency for non-hemorrhagic reasons or when perioperative t ransfusion requirements reached 10 units (P < 0.001). Morbidity follow ed the same distribution. Death resulted primarily from shock, myocard ial infarction, or sepsis from an anastomotic leak. Limiting transfusi on needs to less than 10 units, by either more aggressive evaluation o r earlier operation, and more liberal use of ileostomy were the only m aneuvers identified that may decrease risk in the emergency setting. E lective operation before complications arise will likely result in imp rovement in morbidity and mortality rates.