Purpose: Surgery for ischemic colitis is associated with high perioperative morbidity and mortality, but the risk factors for mortality and major surgical complications are unclear. Methods: In this retrospective single institution cohort study of all patients undergoing colorectal surgery for histologically proven ischemic colitis between 2004 and 2010, we evaluated surgical outcomes and risk factors for in-hospital mortality and major surgical complications. Results: For the 100 patients included in the study, in-hospital mortality was 54%; major surgical complications, defined as anastomotic leakage or rectal stump and stoma complications, occurred in 16%. In the multivariable analysis, hospital death was more likely in patients with right-sided (odds ratio [OR] 3.8; 95% confidence interval [CI] 1.2, 12; P = 0.022) or pan-colonic ischemia (OR 11; 95% CI 2.8, 39; P < 0.001), both relative to left-sided ischemia. Decreased preoperative pH level (OR 2.5 per 0.1 decrease; 95% CI 1.5, 4.1; P < 0.001) and prior cardiac or aortic surgery (OR 2.4; 95% CI 0.82, 6.8; P = 0.109) were further important risk factors for in-hospital mortality. Major postoperative surgical complications were more likely in patients with ischemic alterations at the resection margin of the histological specimen (OR 3.7; 95% CI 1.2, 11; P = 0.022). Conclusions: Colonic resection for ischemic colitis is associated with high in-hospital mortality, especially in patients with right-sided or pan-colonic ischemia. In patients developing acidosis, early laparotomy is essential. Since resection margins' affection seems to be underestimated upon surgery, resections should be performed wide enough within healthy tissue
