Abstract
Background:
Traumatic colorectal injuries can be managed by either fecal diversion or primary repair / resection and anastomosis. We aimed to study differences in outcomes in adult patients managed with or without fecal diversion at time of initial operation.
Methodology:
Using ICD-9 codes adult patients (18 years and older) in the National Trauma Databank with colonic and rectal injuries were identified for the years 2013-2015. The following datapoints were collected: age, gender, race, injury severity score (ISS), pulse rate, systolic blood pressure (SBP) and length of stay (LOS). Subjects with missing data or cardiac arrest at time of arrival were excluded.
Patients were divided into two groups based on whether or not fecal diversion was performed at time of initial operation. Incidence of the following morbidities was analyzed: acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), deep vein thrombosis (DVT), pulmonary embolism (PE), pneumonia, deep surgical site infection (SSI), severe sepsis, unplanned intubation and unplanned return to OR.
Statistical analysis was conducted using SPSS for windows. P-value < 0.05 was considered statistically significant.
Results
Of 2,598,467 patients, 8434 (0.32%) sustained a colonic or rectal injury. Mean age was 32.1 years. 87.8% were male. 665 patients (Group 1) underwent fecal diversion while 3866 (Group 2) underwent resection / anastomosis or primary repair.
Groups 1 and 2 were noted to be similar in terms of ISS (median of 14 in both groups), age (33.9 vs 33.1 years; p=0.15), percentage of male patients (87.1% vs 88.7%; p=0.23), SBP (125 vs 123 mmHg; p=0.051) and pulse rate (95.8 vs 97.3; p=0.46) respectively.
No statistically significant differences were found in the incidence of AKI (Odds ratio (OR): 1.29, 95% confidence interval (CI) 0.823-2.04), ARDS (OR: 1.42, 95% CI 0.732-2.75), DVT (OR: 1.38, 95% CI 0.827-2.30), pulmonary embolism (OR: 0.808, 95% CI 0.451-1.45), pneumonia (OR: 1.03, 95% CI 0.729-1.47), deep SSI (OR: 0.768, 95% CI 0.522-1.13), severe sepsis (OR: 1.37, 95% CI 0.862-2.17), unplanned intubation (OR: 1.15, 95% CI 0.650-2.02) or unplanned return to operating room (OR: 1.10, 95% CI 0.793-1.53).
LOS was 15.3 and 15.2 days for groups 1 and 2 respectively (p=0.92).
Conclusion
There does not appear to be a difference in outcomes between patients who undergo fecal diversion and those who do not. Therefore the decision to perform resection / anastomosis or primary repair should not be influenced by a concern for post-operative fecal leakage and subsequent morbidity but should be based on hemodynamic status and extent of injury.