American journal of surgery · 2023
Proximal protective diverting ostomy following colon anastomosis for penetrating trauma may not be protective: A matched cohort study.
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Dilday Joshua, Chien Chih Ying, Lewis Meghan R, Benjamin Elizabeth R, Demetriades Demetrios
Аннотация
INTRODUCTION: Despite the shift toward liberal primary anastomosis in penetrating colon injuries, some surgeons recommend a protective diverting ostomy (DO) proximal to the anastomosis. This study evaluates the effect of DO on outcomes in patients undergoing colon resection and anastomosis following penetrating trauma.
METHODS: The TQIP database (2013-2018) was queried for penetrating colon injuries undergoing colectomy and anastomosis. Patients receiving DO were propensity matched to patients without diverting ostomy (woDO) (1:3). Outcomes were compared between groups.
RESULTS: After matching, 89 DO patients were analyzed. The DO group had more surgical site infections (32 % vs. 21 %; p < 0.05) and longer hospital stay (20 [13-27] vs. 15 [9-25]; p < 0.05) compared to the woDO group. Mortality and unplanned operations were similar between groups.
CONCLUSIONS: Diverting ostomy after colon resection and anastomosis is associated with increased infectious complications without decreasing unplanned operations or mortality. Its routine role in penetrating colon trauma needs reassessment.
METHODS: The TQIP database (2013-2018) was queried for penetrating colon injuries undergoing colectomy and anastomosis. Patients receiving DO were propensity matched to patients without diverting ostomy (woDO) (1:3). Outcomes were compared between groups.
RESULTS: After matching, 89 DO patients were analyzed. The DO group had more surgical site infections (32 % vs. 21 %; p < 0.05) and longer hospital stay (20 [13-27] vs. 15 [9-25]; p < 0.05) compared to the woDO group. Mortality and unplanned operations were similar between groups.
CONCLUSIONS: Diverting ostomy after colon resection and anastomosis is associated with increased infectious complications without decreasing unplanned operations or mortality. Its routine role in penetrating colon trauma needs reassessment.