Total abdominal colectomy: conditions defining outcome

Published conclusions that total abdominal colectomy is a safe procedure need to be qualified by analysis of specific risk groups. We reviewed the records of 87 consecutive patients undergoing total abdominal colectomy at our institution to determine the factors affecting morbidity and mortality. Underlying disease and urgency of operation were the primary determinants of outcome. Mortality was 5.9 per cent in the patient 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 either as an emergency for non-hemorrhagic reasons or when perioperative transfusion requirements reached 10 units (P < 0.001). Morbidity followed the same distribution. Death resulted primarily from shock, myocardial infarction, or sepsis from an anastomotic leak. Limiting transfusion needs to less than 10 units, by either more aggressive evaluation or earlier operation, and more liberal use of ileostomy were the only maneuvers identified that may decrease risk in the emergency setting. Elective operation before complications arise will likely result in improvement in morbidity and mortality rates.