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Risk Factors for Morbidity & Mortality Following Colorectal Surgery

Purpose: To evaluate a patient undergoing colorectal surgery for the risk of morbidity and mortality based on the study of Alves et al.

Description

Alves et al identified risk factors for morbidity and mortality in French patients undergoing colorectal surgery. These can help identify patients at significant risk prior to the surgery, which allows for more aggressive management postoperatively. The authors are from Hopital Lariboisiere (Paris), Hopital Jean Minjoz (Besancon), and Hotel Dieu (Clermont-Ferrand) in France.


Surgery was done for colorectal cancer and diverticular disease.

 

Risk Factor

Risk Mortality

Risk Morbidity

age > 70

x

x

unexplained weight loss > 10%

x

 

neurological comorbidity

x

x

emergency surgery

x

 

hypoalbuminemia

 

x

cardiorespiratory comorbidity

 

x

long duration of operation (> 120 minutes)

 

x

peritoneal contamination

 

x

 

where:

• Neurological comorbidity includes stroke and functional disability.

• Cardiorespiratory comorbidity includes myocardial infarction, atrial fibrillation, chronic obstructive pulmonary disease, smoking, and the need for cardiac medications.

• The criteria for hypoalbuminemia was not specified. I will use less than the lower limit of the normal reference range in the implementation. An alternative is to use <= 3.0 g/dL.

 

number of risk factors for mortality =

= SUM(number of risk factors present)

 

Interpretation:

• minimum number of risk factors associated with morbidity: 0

• maximum number of risk factors associated with morbidity: 4

 

Number of Risk Factors for Mortality

Probability of Death

0

0.5%

1

2%

2

9%

3

16%

4

50%

from Table 2, page 280


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Specialty

Objective

ICD-10