Our Summary

This study found that a significant number of patients who undergo emergency or urgent surgery to remove part or all of the colon (a colectomy) end up needing another surgery within 30 days. Around 12.4% of the 16,004 patients studied had to go back to the operating room. This was linked to worse outcomes, including a higher death rate (16.7% vs 9.6%), a longer stay in the hospital (17 days vs 10 days), and a higher chance of being readmitted to the hospital (21% vs 12.1%). Patients who needed another surgery were also less likely to be discharged home (62.3% vs 36.8%). The highest rate of second surgeries was among patients who had their first surgery due to blood vessel-related issues. Other factors linked to a higher chance of needing another surgery included being male, having low albumin (a protein that can indicate malnutrition), being sicker before surgery, and needing dialysis or a ventilator before surgery. The researchers believe more work is needed to figure out how to prevent these second surgeries.

FAQs

  1. What is the rate of reoperation in patients undergoing urgent/emergent colectomies?
  2. What factors are associated with a higher likelihood of reoperation following an urgent/emergent colectomy?
  3. What are the outcomes for patients who undergo reoperation within 30 days of an urgent/emergent colectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about colectomy is to follow post-operative care instructions carefully to reduce the risk of complications and the need for reoperation. This may include taking prescribed medications, maintaining a healthy diet, staying active, and attending follow-up appointments with your healthcare provider. It’s also important to report any unusual symptoms or concerns to your doctor promptly.

Suitable For

Patients who are typically recommended for colectomy include those with severe inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease, patients with colorectal cancer, patients with severe diverticulitis, patients with toxic megacolon, patients with colonic obstruction, and patients with ischemic colitis. Additionally, patients who have failed medical management for their condition or who have complications such as perforation, abscess, or uncontrolled bleeding may also be recommended for colectomy.

Timeline

Before colectomy:

  1. Patient presents with symptoms such as abdominal pain, bleeding, or bowel obstruction.
  2. Patient undergoes diagnostic tests such as colonoscopy or imaging studies to determine the need for surgery.
  3. Surgery is scheduled as urgent/emergent based on the severity of the condition.
  4. Patient undergoes pre-operative preparation, which may include bowel preparation and medical optimization.

After colectomy:

  1. Patient undergoes surgery to remove a portion or the entire colon.
  2. Post-operative recovery begins in the hospital, with monitoring for complications such as infection or bleeding.
  3. If reoperation is necessary within 30 days, it is performed to address complications or issues related to the initial surgery.
  4. Patients who undergo reoperation have increased 30-day mortality, longer hospital stays, higher readmission rates, and are less likely to be discharged home.
  5. Factors associated with reoperation include male gender, low albumin levels, higher ASA classification, and presence of pre-operative sepsis, dialysis, or ventilator dependence.
  6. Further research is needed to explore strategies to reduce reoperations in patients undergoing urgent/emergent colectomies.

What to Ask Your Doctor

  1. What specific indication or condition is necessitating the urgent/emergent colectomy?
  2. What are the risks and potential complications associated with the colectomy procedure?
  3. What factors may increase the likelihood of needing a reoperation following the colectomy?
  4. How will the healthcare team monitor for and respond to any potential complications that may arise post-operatively?
  5. What is the typical recovery process and timeline following a colectomy?
  6. Are there any specific lifestyle changes or precautions that should be taken after the colectomy procedure?
  7. How frequently will follow-up appointments be needed to monitor progress and address any concerns?
  8. What are the signs and symptoms that may indicate the need for immediate medical attention or a potential reoperation?
  9. Are there any alternative treatment options or surgical approaches that could be considered in place of a colectomy?
  10. What can be done to minimize the risk of needing a reoperation following the colectomy procedure?

Reference

Authors: Dillon CH, Vos DG, McCahill LE. Journal: Am J Surg. 2023 Mar;225(3):558-563. doi: 10.1016/j.amjsurg.2022.11.003. Epub 2022 Nov 8. PMID: 36414473