Improved Outcomes in Colon and Rectal Surgery part 28. Written by many of the worlds leading colorectal surgeons, this evidence-based text investigates the risks and benefits of colorectal surgeries. By using clinical pathways, algorithms, and case discussions, the authors identify the best practices for patient safety and positive outcomes to ensure that physicians correctly recognize potential problems and carefully manage complications | improved outcomes in colon and rectal surgery Table The Mannheim peritonitis index. Risk Factor Scores Age 50 5 Female Sex 5 Organ Failurea 7 Malignancy 4 Preoperative duration of peritonitis 24 hours 4 Origin of sepsis not colonic 4 Diffuse generalized peritonitis 6 Exudate Clear 0 Cloudy Purulent 6 Fecal 12 a. Kidney failure creatinine level 177 umol L or urea level 167 mmol L or oliguria 20 ml hour pulmonary Insufficiency PO2 50 mmHg or PCO2 50 mmHg Intestinal obstruction paralysis 24 hours or complete Mechanical ileus shock hypodynamic or hyperdynamic they compared the POSSUM cr Colorectal -POSSUM and p General Surgery -POSSUM they found that POSSUM over predicted mortality while p-POSSUM and cr-POSSUM under predicted mortality for diverticular disease but correctly predicted mortality for cancer. In a confirmatory study here in the US however Senagore found that all of the POSSUM scoring systems over predicted mortality. 68 69 Another scoring system that has been developed and used frequently in discussing outcomes and indications for the different types of operations performed is the Mannheim Peritonitis Index. Many studies have evaluated the efficacy of this scoring system. Bielecki found that patients with colonic perforation and an MPI 25 had a 55 morbidity rate and 35 wound infection rate. 70 Another study confirmed these findings after evaluating 172 patients with peritonitis the MPI was able to predict 12 of the 14 deaths. They also found that morbidity was related to the MPI score. 71 Table Complications of Procedure Anastomotic Leak Elective colectomy has been well documented to carry a very low anastomotic leak rate of about 1-3 . 64 However in the face of active inflammation or peritonitis attempts at performing a primary anastomosis carry a higher risk of anastomotic dehiscence. Primary anastomosis in the setting of Hinchey stage III or IV carries a leak rate from 8-22 . 21 64 65 72-74 Mortality Elective colectomy also carries with it a .
