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Intestinal infarctions: a reappraisal of the factors predictive of operative mortality
P Goudet1, T Michelin, P Rousseau
1Chirurgie Viscérale et Urgences, Clinique Chirurgicale Universitaire, University Hospital of Burgundy, Dijon, France.
Objective:
To assess the factors that predict operative mortality after intestinal infarction, and show what effect referral patterns have on mortality.
Design:
Retrospective study.
Setting:
Two university departments of surgery, France.
Subjects:
144 patients with intestinal infarctions operated on between January 1980 and August 1995.
Interventions:
Univariate and multivariate analyses.
Main Outcome Measures:
Operative mortality and the factors associated with it.
Results:
Operative mortality was 67% (96/144) during the first 45 days postoperatively. The univariate analysis showed that age over 75 years (p=0.0002), female sex (p=0.007), the presence of shock (p < 0.0001), and referral from cardiovascular medical or surgical unit (p=0.01) were significantly associated with mortality. However, the multivariate analysis reduced these to extent of infarction (p=0.0001), the presence of shock (p=0.0002), age over 75 years (p=0.0001), and recent cardiac or vascular operation (p=0.03).
Conclusions:
The influence of referral pattern was related to previous cardiac or vascular operation, and the risk among women to the fact that their age was 10 years older than that of men. This study shows how the type of referral may explain the wide variations in reported mortality. To compare published series, care should be taken to avoid any selection bias.