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Lookup NU author(s): John Hammond
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2021, The Author(s).Background: Patients with cirrhosis undergoing colectomy have a higher risk of postoperative mortality, but contemporary estimates are lacking and data on associated risk and longer term outcomes are limited. This study aimed to quantify the risk of mortality following colectomy by urgency of surgery and stage of cirrhosis. Data sources. Linked primary and secondary-care electronic healthcare data from England were used to identify all patients undergoing colectomy from January 2001 to December 2017. These patients were classified by the absence or presence of cirrhosis and severity. Case fatality rates at 90 days and 1 year were calculated, and cox regression was used to estimate the hazard ratio of postoperative mortality controlling for age, gender and co-morbidity. Results: Of the total, 36,380 patients undergoing colectomy, 248 (0.7%) had liver cirrhosis, and 70% of those had compensated cirrhosis. Following elective colectomy, 90-day case fatality was 4% in those without cirrhosis, 7% in compensated cirrhosis and 10% in decompensated cirrhosis. Following emergency colectomy, 90-day case fatality was higher; it was 16% in those without cirrhosis, 35% in compensated cirrhosis and 41% in decompensated cirrhosis. This corresponded to an adjusted 2.57 fold (95% CI 1.75–3.76) and 3.43 fold (95% CI 2.02–5.83) increased mortality risk in those with compensated and decompensated cirrhosis, respectively. This higher case fatality in patients with cirrhosis persisted at 1 year. Conclusion: Patients with cirrhosis undergoing emergency colectomy have a higher mortality risk than those undergoing elective colectomy both at 90 days and 1 year. The greatest mortality risk at 90 days was in those with decompensation undergoing emergency surgery.
Author(s): Adiamah A, Crooks CJ, Hammond JS, Jepsen P, West J, Humes DJ
Publication type: Article
Publication status: Published
Journal: International Journal of Colorectal Disease
Year: 2022
Volume: 37
Pages: 607-616
Print publication date: 01/03/2022
Online publication date: 11/12/2021
Acceptance date: 30/10/2021
Date deposited: 13/01/2022
ISSN (print): 0179-1958
ISSN (electronic): 1432-1262
Publisher: Springer Science and Business Media Deutschland GmbH
URL: https://doi.org/10.1007/s00384-021-04061-y
DOI: 10.1007/s00384-021-04061-y
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