Perioperative Care Related Events are Different Following Elective and Emergency Right Hemicolectomy

Abstract

Introduction: Right hemicolectomy is frequently performed for malignancy but emergency surgery is associated with double the mortality rate of elective colonic resection. The study was designed to compare perioperative clinical incidents patients who died following elective and emergency right hemicolectomy. Methods: Adult patients who died under the care of a surgeon following elective and emergency right hemicolectomy in Queensland, Australia were identified from the Australian and New Zealand Audit of Surgical Mortality (ANZASM) database. Demographic data, free text entries and surgeon reviewer conclusions were analysed. Results: The two groups had different indications for surgery but were of similar age and gender. Surgeon reviewers (first and second line) identified similar rates of untoward perioperative events in both groups however post operative events tended towards being more frequent after elective surgery while pre operative events were more frequent in the emergency group. Almost half of the incidents occurred post operatively and often related to delayed diagnosis and management of anastomotic leak. Conclusion: This analysis suggests more thorough pre operative medical work up may be required prior to right hemicolectomy and that greater attention should be focused on recognizing intra-abdominal sepsis - predominantly following emergency surgery.