TY - JOUR
T1 - Colorectal resection in emergency general surgery
T2 - An EAST multicenter trial
AU - Aicher, Brittany O.
AU - Hernandez, Matthew C.
AU - Betancourt-Ramirez, Alejandro
AU - Grossman, Michael D.
AU - Heise, Holly
AU - Schroeppel, Thomas J.
AU - Kongkaewpaisan, Napaporn
AU - Kaafarani, Haytham M.A.
AU - Wagner, Afton
AU - Grabo, Daniel
AU - Scott, Michael
AU - Peck, Gregory
AU - Chang, Gloria
AU - Matsushima, Kazuhide
AU - Cullinane, Daniel C.
AU - Cullinane, Laura M.
AU - Stocker, Benjamin
AU - Posluszny, Joseph
AU - Simonoski, Ursula J.
AU - Catalano, Richard D.
AU - Vasileiou, Georgia
AU - Yeh, D. Dante
AU - Agrawal, Vaidehi
AU - Truitt, Michael S.
AU - Pickett, Maryanne
AU - Dultz, Linda
AU - Muller, Alison
AU - Ong, Adrian W.
AU - San Roman, Janika L.
AU - Barth, Nadine
AU - Fackelmayer, Oliver
AU - Velopulos, Catherine G.
AU - Hendrix, Cheralyn
AU - Estroff, Jordan M.
AU - Gambhir, Sahil
AU - Nahmias, Jeffry
AU - Jeyamurugan, Kokila
AU - Bugaev, Nikolay
AU - Portillo, Victor
AU - Carrick, Matthew M.
AU - O'Meara, Lindsay
AU - Kufera, Joseph
AU - Zielinski, Martin D.
AU - Bruns, Brandon R.
N1 - Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - 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.
AB - 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.
KW - Emergency general surgery
KW - colon anastomosis
KW - colon resection
KW - ostomy
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U2 - 10.1097/TA.0000000000002894
DO - 10.1097/TA.0000000000002894
M3 - Article
C2 - 32890337
AN - SCOPUS:85096815545
SN - 2163-0755
VL - 89
SP - 1023
EP - 1031
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 6
ER -