La chirurgia per polipi non maligni ha elevate morbidita e mortalita

Morbidity and mortality after surgery for nonmalignant colorectal polyps.Peery AF, Shaheen NJ, Cools KS, Baron TH, Koruda M, Galanko JA, Grimm IS. Gastrointest Endosc. 2017 Apr 10 [Epub ahead of print]

BACKGROUND & AIMS:Despite evidence that most non-malignant colorectal polyps can be managed endoscopically, a substantial proportion of patients with a non-malignant colorectal polyp are still sent to surgery. Risks associated with this surgery are not well characterized. We aimed to describe 30-day post-operative morbidity and mortality and to explore risk factors for adverse events in patients undergoing surgical resection for non-malignant colorectal polyps.

METHODS:We analyzed data collected prospectively as part of the National Surgical Quality Improvement Program. Our analysis included 12,732 patients who underwent elective surgery for a non-malignant colorectal polyp from 2011 through 2014. We report adverse events within 30 days of the index surgery. Modified Poisson regression was used to estimate risk ratios and 95% confidence intervals.RESULTS:Thirty-day mortality was 0.7%. The risk of a major post-operative adverse event was 14%. Within 30 days of resection, 7.8% of patients were readmitted and 3.6% of patients had a second major surgery. The index surgery resulted in a colostomy in 1.8% and ileostomy in 0.4% of patients. Patients who had surgical resection of a non-malignant polyp in the rectum or anal canal compared with the colon had a risk ratio of 1.58 (95% CI, 1.09-2.28) for surgical site infection and 6.51 (95% CI, 4.97-8.52) for ostomy.CONCLUSION:Surgery for a non-malignant colorectal polyp is associated with significant morbidity and mortality. A better understanding of the risks and benefits associated with surgical management of non-malignant colorectal polyps will better inform discussions regarding the relative merits of management strategies.

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