Primary repair versus resection for American Association for the Surgery of Trauma grades I and II colon injuries: Does the management approach really matter? An Eastern Association for the Surgery of Trauma multicenter trial.
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Fitzgerald Caitlin A, Barnes Christopher, Bisgaard Erika K, McLafferty Bryant J, Harrell Kevin N, Fleming Matthew M, Meizoso Jonathan P, Walker James, Sciarretta Jason D, Succar Bahaa E, Cheng Mingyuan, Lewis Richard H, Davis Greggory R, Puli Odessa, Egodage Tanya, Mooney Jennifer, Nguyen Stacy, Kirsch Jordan M, Jose Anna Mary, Lumbard Derek, Finn Andreana, Sheppard Kyle, Shively Korey S, Butts Caleb, Lasinski Alaina M, Beattie Nicholas G, Noory Mary N, Chaudhary Sejul A, Irish William, Leung Pak, Luketic Karla, Noorbakhsh Matthew, Almahmoud Khalid, Cash Alison, Bernard Andrew C, Kumar Arathi, DeSantis Anthony J, Kozar Rosemary A, Prasad Ajay, Siletz Anaar E, Schroeppel Thomas J, Rodriquez Jennifer, Tackett Nichole, Mentzer Caleb, Sabu-Kurian Anna, Bankhead Brittany K, Bhattacharya Bishwajit, Maung Adrian A, Chang Grace, Ramoutar Uma, Farrell Michael S, Hamdan Marah, Wong Yee M, Deci Ryan T, Fernandez Luis, Pero Brandi, Palacio Carlos H, Rendon Garcia Juan J, Myall James J, Riggle Andrew J, Golestani Simin, Dilday Joshua, Miller April, Taveras Luis, Grande Payton, Scott Stephanie, Dumas Ryan P
Аннотация
METHODS: This was a retrospective, multicenter analysis of all patients presenting with AAST grades I and II colon injuries to 32 Level 1 trauma centers from 2011 to 2021. Based on operative documentation, patients were dichotomized into two groups, those who underwent PR or RWA. Outcomes included length of stay, infectious complications, and mortality. Multivariate logistic regression was performed to determine the independent effect of operative technique on outcomes.
RESULTS: A total of 2,022 patients met the inclusion criteria for this study. Most were young (36 [24-44] years), male (79.6%), and presented after penetrating trauma (58.2%). A total of 1,013 patients presented with a grade I injury, while 1,009 patients presented with a grade II injury. Furthermore, 1,314 patients underwent PR, and 708 underwent RWA. While there was no difference in Injury Severity Score between PR and RWA, RWA was associated with more adverse outcomes including surgical site infections, suture line failure/leak, fascial dehiscence, and a longer hospital length of stay (all p < 0.001). When controlling for mechanism of injury, AAST grade, Injury Severity Score, and number of intra-abdominal injuries RWA were independently associated with more infectious complications including superficial, deep, and organ space surgical site infections.
CONCLUSION: Resection with anastomosis was independently associated with more adverse outcomes including multiple infectious complications and longer hospital length of stay compared with PR, suggesting that low-grade colon injuries can be safely managed with PR alone.
LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.