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.