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Section of Colon and Rectal Surgery, Department of Surgery, University of Louisville, Louisville, KY 40292, USAPrice Institute of Surgical Research, University of Louisville, Louisville, KY, USABlizard Institute of Cell & Molecular Science, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
Over the past 90 years, colorectal resection has been associated with a progressive
increase in safety for what is still a major and frequently performed operation. It
has often been stated that the wide use of antibiotics after World War II was associated
with increasing survival after colon surgery [
] and the improved care overall associated with the proliferation of intensive care
units in the 1990s correlate better with those improvements. Although there are still
outliers in institutional mortality rates in colon surgery, the mortality rate for
a large number of voluntarily reporting university teaching and affiliated hospitals
is just under 2% for elective operations. Interestingly, even after anastomotic leak,
rescue by an early diagnosis and appropriate systemic management, often including
diversion, is so much the rule that death rates are still low (Fig. 1) [
Fig. 1Colon resection risk adjusted mortality by hospital for the fourth quarter of 2004
through the first quarter of 2010. These data were provided by the University HealthSystem
Consortium and reflects results in 101, 722 patients, of whom 1774 died in hospitals.
The risk adjustment was accomplished by proprietary logistic regression modeling techniques,
where each patient is assigned a severity of illness level and with it expected length
of stay, costs, and mortality. Although the overall mortality is acceptable, it is
apparent that some hospitals (to the far right on this figure) have considerable room
for improvement (Polk HC Jr, Hohmann S, unpublished data, 2011). Red line is the median.
Nonelective excisional colorectal surgery in English National Health Service Trusts: a study of outcomes from Hospital Episode Statistics Data between 1996 and 2007.
Do preoperative oral antibiotics influence sepsis rates following elective colorectal surgery in patients receiving perioperative intravenous prophylaxis?.
Efficacy of mechanical bowel preparation with polyethylene glycol in prevention of postoperative complications in elective colorectal surgery: a meta analysis.
