Risk Factors for Complications Following Colon Resection

Risk factors:

(1) age >= 70 years

(2) number of pre-existing conditions

(3) emergency surgery

(4) peri-operative complications

where:

• 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.

Recommendations:

(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.

Limitations:

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