Title

Colorectal resection in emergency general surgery: An EAST multicenter trial

Authors

Brittany O. Aicher, University of Maryland R Adams Cowley Shock Trauma Center
Matthew C. Hernandez, Mayo Clinic
Alejandro Betancourt-Ramirez, Southside Hospital
Michael D. Grossman, Southside Hospital
Holly Heise, Memorial Hospital Central
Thomas J. Schroeppel, Memorial Hospital Central
Napaporn Kongkaewpaisan, Massachusetts General Hospital
Haytham M.A. Kaafarani, Massachusetts General Hospital
Afton Wagner, West Virginia University School of Medicine Morgantown
Daniel Grabo, West Virginia University School of Medicine Morgantown
Michael Scott, Robert Wood Johnson University Hospital
Gregory Peck, Robert Wood Johnson University Hospital
Gloria Chang, University of Southern California
Kazuhide Matsushima, University of Southern California
Daniel C. Cullinane, Marshfield Clinic
Laura M. Cullinane, Marshfield Clinic
Benjamin Stocker, Northwestern Memorial Hospital
Joseph Posluszny, Northwestern Memorial Hospital
Ursula J. Simonoski, Loma Linda University Medical Center
Richard D. Catalano, Loma Linda University Medical Center
Georgia Vasileiou, Jackson Memorial Hospital
D. Dante Yeh, Jackson Memorial Hospital
Vaidehi Agrawal, Methodist Dallas Medical Center
Michael S. Truitt, Methodist Dallas Medical Center
Maryanne Pickett, UT Southwestern Medical Center
Linda Dultz, UT Southwestern Medical Center
Alison Muller, Reading Hospital
Adrian W. Ong, Reading Hospital
Janika L. San Roman, Cooper University Hospital
Nadine Barth, Cooper University Hospital
Oliver Fackelmayer, University of Colorado Denver
Catherine G. Velopulos, University of Colorado Denver

Document Type

Journal Article

Publication Date

12-1-2020

Journal

Journal of Trauma and Acute Care Surgery

Volume

89

Issue

6

DOI

10.1097/TA.0000000000002894

Keywords

colon anastomosis; colon resection; Emergency general surgery; ostomy

Abstract

OBJECTIVE Evidence comparing stoma creation (STM) versus anastomosis after urgent or emergent colorectal resection is limited. This study examined outcomes after colorectal resection in emergency general surgery patients. METHODS This was an Eastern Association for the Surgery of Trauma-sponsored prospective observational multicenter study of patients undergoing urgent/emergent colorectal resection. Twenty-one centers enrolled patients for 11 months. Preoperative, intraoperative, and postoperative variables were recorded. ?2, Mann-Whitney U test, and multivariable logistic regression models were used to describe outcomes and risk factors for surgical complication/mortality. RESULTS A total of 439 patients were enrolled (ANST, 184; STM, 255). The median (interquartile range) age was 62 (53-71) years, and the median Charlson Comorbidity Index (CCI) was 4 (1-6). The most common indication for surgery was diverticulitis (28%). Stoma group was older (64 vs. 58 years, p < 0.001), had a higher CCI, and were more likely to be immunosuppressed. Preoperatively, STM patients were more likely to be intubated (57 vs. 15, p < 0.001), on vasopressors (61 vs. 13, p < 0.001), have pneumoperitoneum (131 vs. 41, p < 0.001) or fecal contamination (114 vs. 33, p < 0.001), and had a higher incidence of elevated lactate (149 vs. 67, p < 0.001). Overall mortality was 13%, which was higher in STM patients (18% vs. 8%, p = 0.02). Surgical complications were more common in STM patients (35% vs. 25%, p = 0.02). On multivariable analysis, management with an open abdomen, intraoperative blood transfusion, and larger hospital size were associated with development of a surgical complication, while CCI, preoperative vasopressor use, steroid use, open abdomen, and intraoperative blood transfusion were independently associated with mortality. CONCLUSION This study highlights a tendency to perform fecal diversion in patients who are acutely ill at presentation. There is a higher morbidity and mortality rate in STM patients. Independent predictors of mortality include CCI, preoperative vasopressor use, steroid use, open abdomen, and intraoperative blood transfusion. Following adjustment by clinical factors, method of colon management was not associated with surgical complications or mortality. LEVEL OF EVIDENCE Therapeutic study, level IV.

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