A comparison of the surgical mortality due to colorectal perforation at different hospitals with data from 10,090 cases in the Japanese National Clinical Database

Abstract

Colorectal perforation has a high rate of mortality. We compared the incidence and fatality rates of colorectal perforation among different hospitals in Japan using data from the nationwide surgical database.Patients were registered in the National Clinical Database (NCD) between January 1st, 2011 and December 31st, 2013. Patients with colorectal perforation were identified from surgery records by examining if acute diffuse peritonitis (ADP) and diseases associated with a high probability of colorectal perforation were noted. The primary outcome measures included the 30-day postsurgery mortality and surgical mortality of colorectal perforation. We analyzed differences in the observed-to-expected mortality (O/E) ratio between the two groups of hospitals, that is, specialized and non-specialized, using the logistic regression analysis forward selection method.There were 10,090 cases of disease-induced colorectal perforation during the study period. The annual average postoperative fatality rate was 11.36%. There were 3884 patients in the specialized hospital group and 6206 in the non-specialized hospital group. The O/E ratio (0.9106) was significantly lower in the specialized hospital group than in the non-specialized hospital group (1.0704). The experience level of hospitals in treating cases of colorectal perforation negatively correlated with the O/E ratio.We conducted the first study investigating differences among hospitals with respect to their fatality rate of colorectal perforation on the basis of data from a nationwide database. Our data suggest that patients with colorectal perforation should choose to be treated at a specialized hospital or a hospital that treats five or more cases of colorectal perforation per year. The results of this study indicate that specialized hospitals may provide higher quality medical care, which in turn proves that government policy on healthcare is effective at improving the medical system in Japan.

Broken beer bottle as a cause of sigmoid perforation: A summary of causes and predictors in the management of traumatic and non-traumatic colorectal perforation

“…However, the presence of profuse bleeding, advanced age, presence of comorbidities and sepsis are predictors of poor prognosis in these cases [7] , [9] , [14] , [15] , [16] . In general, perforation secondary to non-traumatic causes is more frequent, being predominantly due to colorectal cancer, ischemia, diverticulitis, inflammatory bowel disease, inadequate use of enema, iatrogenic endoscopy or anorectal manometry or fecal impaction [6] , [7] , [9] , [10] , [11] , [12] , [13] , [14] . Favorable prognostic factors for a satisfactory outcome in both traumatic and non-traumatic causes are early initiation of surgery and care in a specialized surgical center [6] , [12] .…”

“…In general, perforation secondary to non-traumatic causes is more frequent, being predominantly due to colorectal cancer, ischemia, diverticulitis, inflammatory bowel disease, inadequate use of enema, iatrogenic endoscopy or anorectal manometry or fecal impaction [6] , [7] , [9] , [10] , [11] , [12] , [13] , [14] . Favorable prognostic factors for a satisfactory outcome in both traumatic and non-traumatic causes are early initiation of surgery and care in a specialized surgical center [6] , [12] . The unfavorable prognostic factors are advanced age, requirement of mechanical ventilation, prolonged stay in hospital and intensive care unit, APACHE II (Acute Physiology and Chronic Health Evaluation II) score between 8 and 30, SOFA (Sequential Organ Failure Assessment) score between 0 and 12, DIC (Disseminated Intravascular Coagulation) score between 0 and 8, POSSUM (Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity) score between 34 and 74, CT (Computerized Tomography) dirty mass volume in cm 3 (234 ± 211), presence of profuse bleeding, use of conservative treatment, performance of primary anastomosis without a diverting stoma, ASA Grade 3, 4 or 5, chronic steroid use, serum creatinine level > 3.0 mg/dL, disseminated cancer, white blood cell count <3500/mL, low preoperative systolic blood pressure and Hinchey classification IV [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] .…”

“…The presence of unfavorable factors prolongs hospital stay, the risk of reoperation, perianal infection, peritonitis, sepsis and wound infection, generating mortality rates of up to 38% [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] . Considering the large number of cases and the heterogeneity of outcomes, it is clear that there is still much to be defined in the management of colorectal perforation.…”

“…We excluded those articles that did not present data on causes, predictors and outcomes of colorectal perforation, as well as those that did not have full text available. After the application of these criteria, 12 studies were finally included [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] . This case report followed the SCARE guidelines for its realization [18] .…”

A comparison of the surgical mortality due to colorectal perforation at different hospitals with data from 10,090 cases in the Japanese National Clinical Database

“…In the article, “A comparison of the surgical mortality due to colorectal perforation at different hospitals with data from 10,090 cases in the Japanese National Clinical Database”, [ 1 ] which appeared in Volume 96, Issue 2 of Medicine , Dr. Koichi Hirata's affiliations appeared as affiliations j and k, but should have appeared as j, k and l.…”