Title

Validation of the American Association for the Surgery of Trauma Emergency General Surgery Grading System for Colorectal Resection: An EAST Multicenter Study

Authors

Brittany O. Aicher, R Adams Cowley Shock Trauma Center, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland.
Alejandro Betancourt-Ramirez, Department of Surgery, Southside Hospital, Northwell Health, Bay Shore, Bay Shore, NY.
Michael D. Grossman, Department of Surgery, Southside Hospital, Northwell Health, Bay Shore, Bay Shore, NY.
Holly Heise, Department of Surgery, UCHealth Memorial Hospital Central Trauma Center, Colorado Springs, Colorado.
Thomas J. Schroeppel, Department of Surgery, UCHealth Memorial Hospital Central Trauma Center, Colorado Springs, Colorado.
Matthew C. Hernandez, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Martin D. Zielinski, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Napaporn Kongkaewpaisan, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Haytham M. Kaafarani, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Afton Wagner, Department of Surgery, West Virginia University Medicine, Morgantown, West Virginia.
Daniel Grabo, Department of Surgery, West Virginia University Medicine, Morgantown, West Virginia.
Michael Scott, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ.
Gregory Peck, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ.
Gloria Chang, Department of Surgery, University of Southern California, Los Angeles, California.
Kazuhide Matsushima, Department of Surgery, University of Southern California, Los Angeles, California.
Daniel C. Cullinane, Department of Surgery, Marshfield Clinic, Wisconsin.
Laura M. Cullinane, Department of Surgery, Marshfield Clinic, Wisconsin.
Benjamin Stocker, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois.
Joseph Posluszny, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois.
Ursula J. Simonoski, Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA.
Richard D. Catalano, Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA.
Georgia Vasileiou, Dewitt Daughtry Family Department of Surgery, Ryder Trauma Center/Jackson Memorial Hospital, Miami, Florida.
Daniel Dante Yeh, Dewitt Daughtry Family Department of Surgery, Ryder Trauma Center/Jackson Memorial Hospital, Miami, Florida.
Vaidehi Agrawal, Department of Surgery, Methodist Dallas Medical Center, Dallas, Texas.
Michael S. Truitt, Department of Surgery, Methodist Dallas Medical Center, Dallas, Texas.
MaryAnne Pickett, Department of Surgery, University of Texas Southwestern Medical Center and Parkland Hospital, Dallas, Texas.
Linda Dultz, Department of Surgery, University of Texas Southwestern Medical Center and Parkland Hospital, Dallas, Texas.
Alison Muller, Department of Surgery, Reading Hospital, West Reading, Pennsylvania.
Adrian W. Ong, Department of Surgery, Reading Hospital, West Reading, Pennsylvania.
Janika L. San Roman, Cooper University Health Care, Camden, NJ.
Nadine Barth, Cooper University Health Care, Camden, NJ.
Oliver Fackelmayer, Department of Surgery, University of Colorado, Denver, Colorado.

Document Type

Journal Article

Publication Date

5-1-2022

Journal

The American surgeon

Volume

88

Issue

5

DOI

10.1177/0003134820960022

Keywords

colorectal surgery; emergency general surgery

Abstract

BACKGROUND: The American Association for the Surgery of Trauma (AAST) has developed a grading system for emergency general surgery (EGS) conditions. We sought to validate the AAST EGS grades for patients undergoing urgent/emergent colorectal resection. METHODS: Patients enrolled in the "Eastern Association for the Surgery of Trauma Multicenter Colorectal Resection in EGS-to anastomose or not to anastomose" study undergoing urgent/emergent surgery for obstruction, ischemia, or diverticulitis were included. Baseline demographics, comorbidity severity as defined by Charlson comorbidity index (CCI), procedure type, and AAST grade were prospectively collected. Outcomes included length of stay (LOS) in-hospital mortality, and surgical complications (superficial/deep/organ-space surgical site infection, anastomotic leak, stoma complication, fascial dehiscence, and need for further intervention). Multivariable logistic regression models were used to describe outcomes and risk factors for surgical complication or mortality. RESULTS: There were 367 patients, with a mean (± SD) age of 62 ± 15 years. 39% were women. The median interquartile range (IQR) CCI was 4 (2-6). Overall, the pathologies encompassed the following AAST EGS grades: I (17, 5%), II (54, 15%), III (115, 31%), IV (95, 26%), and V (86, 23%). Management included laparoscopic (24, 7%), open (319, 87%), and laparoscopy converted to laparotomy (24, 6%). Higher AAST grade was associated with laparotomy ( = .01). The median LOS was 13 days (8-22). At least 1 surgical complication occurred in 33% of patients and the mortality rate was 14%. Development of at least 1 surgical complication, need for unplanned intervention, mortality, and increased LOS were associated with increasing AAST severity grade. On multivariable analysis, factors predictive of in-hospital mortality included AAST organ grade, CCI, and preoperative vasopressor use (odds ratio (OR) 1.9, 1.6, 3.1, respectively). The American Association for the Surgery of Trauma emergency general surgery grade was also associated with the development of at least 1 surgical complication (OR 2.5), while CCI, preoperative vasopressor use, respiratory failure, and pneumoperitoneum were not. CONCLUSION: The American Association for the Surgery of Trauma emergency general surgery grading systems display construct validity for mortality and surgical complications after urgent/emergent colorectal resection. These results support incorporation of AAST EGS grades for quality benchmarking and surgical outcomes research.

Department

Surgery

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