Boyd et al identified a number of risk factors associated with complications following colon resection. This can help identify a patient at risk for morbidity and mortality associated with surgery. The authors are from the West Virginia University Medical Center.

Risk factors:

(1) age >= 70 years

(2) number of pre-existing conditions

(3) emergency surgery

(4) peri-operative complications


Organ System

Pre-Existing Condition


previous myocardial infarction


congestive heart failure




chronic lung disease




previous lung resection


renal calculi


chronic renal failure


serum creatinine > 2.0 mg/dL

hepatic disease

liver metastases


significant elevations of liver function tests

metabolic conditions

diabetes mellitus




systemic corticosteroid therapy

nutritional status

serum albumin < 3.0 g/dL or other indicator of nutritional problems


peptic ulcer disease


history of previous major surgery



• The text says age > 70 is associated with risk, but looking at the data in Table 3, I would think age should be >=70.

• I am not sure why renal calculi are a risk factor.

• The paper lists albumin in mg/dL. A value of 3 mg/dL would be 0.003 g/dL.

• Some patients with significant liver disease might not have significant elevations of liver function tests. I would probably include an entry for significant liver disease.

• Arthritis would seem important if it was a manifestation of a connective tissue disease or if it was severe enough to be disabling. Minor osteoarthritis would not necessarily increase risk of complications.

• I would think that other conditions could be added (serious pancreatic disease, peripheral vascular disease, immunodeficiency state, etc.).


Observations made by authors:

(1) Increasing age often correlates with having multiple pre-existing conditions. (An elderly person also may do well until something goes wrong, but then can deteriorate once something serious happens).

(2) Pre-existing pulmonary conditions and nutritional problems were associated with increased risk of death from sepsis, especially in emergency cases.



(1) Perform a careful preoperative assessment to identify pre-existing conditions.

(2) Correct any modifiable pre-existing condition, especially nutritional and respiratory problems.

(3) Avoid emergency surgery when possible.

(4) Minimize peri-operative complications.



• The paper was written in 1980. While survival may have increased due to better technologies, the risk factors and recommendations should still apply.

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