Perioperative outcomes of emergency and elective colorectal surgery: a bi-institutional study

Emergency colorectal surgery tends to be associated with poorer outcomes compared to elective colorectal surgery. This study assessed the morbidity and mortality in patients undergoing emergency and elective colorectal resection in two metropolitan hospitals.

Patients were identified retrospectively from two institutions between April 2018 and July 2020. Baseline, operative and postoperative parameters were collected for comparative analysis between emergency and elective surgery groups. A binary logistic regression was performed to identify independent predictors of postoperative complications.

During the study period, 454 patients underwent colorectal resection, 135 were emergency cases (29.74%) and 319 were elective cases (70.26%). Compared with elective resections, patients undergoing emergency resections were observed to have a higher American Society of Anesthesiologists (ASA) score of III to IV (53.33% vs. 38.56%) (P = 0.004). The mortality rate was similar between the emergency and elective group (1.48% vs. 0.63%, P = 0.369). The overall complication rate was higher in patients undergoing emergency resections (64.44% vs. 36.68%, P < 0.001), but the major complication rate was similar between groups (12.59% vs. 10.34%, P = 0.484). Independent predictors for postoperative complications included emergency surgery (Odds Ratio (OR) 2.77, 95% Confidence Interval (CI): 1.66 to 4.61) and an ASA Score of III to IV (OR 2.87, 95% CI: 1.84 to 4.47).

The overall complication rate was higher in patients undergoing emergency colorectal resection, however, rates of major complications and mortality were similar between groups. Higher complication rates reflect advanced disease pathology in patients who are more comorbid.