Colorectal resection in emergency general surgery: An EAST multicenter trial

Brittany O. Aicher, Matthew C. Hernandez, Alejandro Betancourt-Ramirez, Michael D. Grossman, Holly Heise, Thomas J. Schroeppel, Napaporn Kongkaewpaisan, Haytham M.A. Kaafarani, Afton Wagner, Daniel Grabo, Michael Scott, Gregory Peck, Gloria Chang, Kazuhide Matsushima, Daniel C. Cullinane, Laura M. Cullinane, Benjamin Stocker, Joseph Posluszny, Ursula J. Simonoski, Richard D. CatalanoGeorgia Vasileiou, D. Dante Yeh, Vaidehi Agrawal, Michael S. Truitt, Maryanne Pickett, Linda Dultz, Alison Muller, Adrian W. Ong, Janika L. San Roman, Nadine Barth, Oliver Fackelmayer, Catherine G. Velopulos, Cheralyn Hendrix, Jordan M. Estroff, Sahil Gambhir, Jeffry Nahmias, Kokila Jeyamurugan, Nikolay Bugaev, Victor Portillo, Matthew M. Carrick, Lindsay O'Meara, Joseph Kufera, Martin D. Zielinski, Brandon R. Bruns

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)1023-1031
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume89
Issue number6
DOIs
StatePublished - Dec 2020

Keywords

  • Emergency general surgery
  • colon anastomosis
  • colon resection
  • ostomy

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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