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Prognostic Factors of Horiuchi et al for an Older Adult Undergoing Emergency Surgery for a Perforation in the Colon

Description

Horiuchi et al evaluated prognostic factors for patients undergoing emergency surgery to correct a perforation of the colon. These can help to identify a patient who may require more aggressive management. The authors are from Ehime University in Japan.


Patient selection: colon perforation, age > 60 years

 

The most important prognostic factor was the preoperative APACHE2 score.

 

APACHE2 Score

Mortality

<= 10

very low (0%)

10.1 to 15.0

low

15.1 to 20

moderate to high

> 20

very high (100%)

 

Individual preoperative factors associated with mortality:

(1) hypotension

(2) low serum protein (and probably albumin)

(3) high serum creatinine

 

Individual postoperative factors associated with mortality:

(1) hypotension

(2) metabolic acidosis (low pH)

(3) high serum creatinine

(4) low PaO2 to FIO2 ratio

(5) low or normal white blood cell count (failure to show leukocytosis)

 

These tend to reflect multi-organ failures.


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