The surgeon, the surgery, the patient, and the disease: factors complicating colonic surgery.

A review of 231 cases of colonic operations performed during the year 1971 by, or under the supervision of, 32 attending surgeons in an 850 bed private community medical center was undertaken. The overall mortality rate was 5.6% while a 35.5% overall complication rate was also noted. Factors significantly associated with increased overall complication rate were: emergency operations, preoperative anemia (hemoglobin less than 10 gm%), preoperative hypoalbuminemia (serum albumin less than 3 gm%), preoperative obstruction, malignant lesions of the colon and ulcerative colitis, prolonged operation, operations requireing a large quantity of packed cell transfusion, coexisting hepatic disease and operations performed by surgical attending staff under 50 years of age in this institution. Each of these factors is discussed individually. Several factors that were expected to be associated with increased complication rate failed to show significant statistical correlation in this series. These are: age of the patient, coexisting diseases other than hepatic disease, absence of prophylactic parenteral antibiotics, preoperative perforations and operations involving resection of the colon. Hypotheses are offered to explain a number of unexpected poor correlations.