TY - JOUR
T1 - Primary repair versus resection for American Association for the Surgery of Trauma grades I and II colon injuries
T2 - Does the management approach really matter? An Eastern Association for the Surgery of Trauma multicenter trial
AU - Fitzgerald, Caitlin A.
AU - Barnes, Christopher
AU - Bisgaard, Erika K.
AU - McLafferty, Bryant J.
AU - Harrell, Kevin N.
AU - Fleming, Matthew M.
AU - Meizoso, Jonathan P.
AU - Walker, James
AU - Sciarretta, Jason D.
AU - Succar, Bahaa E.
AU - Cheng, Mingyuan
AU - Lewis, Richard H.
AU - Davis, Greggory R.
AU - Puli, Odessa
AU - Egodage, Tanya
AU - Mooney, Jennifer
AU - Nguyen, Stacy
AU - Kirsch, Jordan M.
AU - Jose, Anna Mary
AU - Lumbard, Derek
AU - Finn, Andreana
AU - Sheppard, Kyle
AU - Shively, Korey S.
AU - Butts, Caleb
AU - Lasinski, Alaina M.
AU - Beattie, Nicholas G.
AU - Noory, Mary N.
AU - Chaudhary, Sejul A.
AU - Irish, William
AU - Leung, Pak
AU - Luketic, Karla
AU - Noorbakhsh, Matthew
AU - Almahmoud, Khalid
AU - Cash, Alison
AU - Bernard, Andrew C.
AU - Kumar, Arathi
AU - DeSantis, Anthony J.
AU - Kozar, Rosemary A.
AU - Prasad, Ajay
AU - Siletz, Anaar E.
AU - Schroeppel, Thomas J.
AU - Rodriquez, Jennifer
AU - Tackett, Nichole
AU - Mentzer, Caleb
AU - Sabu-Kurian, Anna
AU - Bankhead, Brittany K.
AU - Bhattacharya, Bishwajit
AU - Maung, Adrian A.
AU - Chang, Grace
AU - Ramoutar, Uma
AU - Farrell, Michael S.
AU - Hamdan, Marah
AU - Wong, Yee M.
AU - Deci, Ryan T.
AU - Fernandez, Luis
AU - Pero, Brandi
AU - Palacio, Carlos H.
AU - Rendon Garcia, Juan J.
AU - Myall, James J.
AU - Riggle, Andrew J.
AU - Golestani, Simin
AU - Dilday, Joshua
AU - Miller, April
AU - Taveras, Luis
AU - Grande, Payton
AU - Scott, Stephanie
AU - Dumas, Ryan P.
N1 - Publisher Copyright:
Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2025/7/1
Y1 - 2025/7/1
N2 - BACKGROUND: The management of traumatic low-grade (American Association for the Surgery of Trauma [AAST] grades I and II) colon injuries has evolved. Recent data suggest that primary repair (PR) or resection over colostomy decreases morbidity and mortality. However, data comparing patients undergoing PR versus resection with anastomosis (RWA) are lacking. We hypothesized that patients presenting with low-grade colon injuries undergoing PR would have fewer postoperative complications than patients undergoing RWA. 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.
AB - BACKGROUND: The management of traumatic low-grade (American Association for the Surgery of Trauma [AAST] grades I and II) colon injuries has evolved. Recent data suggest that primary repair (PR) or resection over colostomy decreases morbidity and mortality. However, data comparing patients undergoing PR versus resection with anastomosis (RWA) are lacking. We hypothesized that patients presenting with low-grade colon injuries undergoing PR would have fewer postoperative complications than patients undergoing RWA. 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.
KW - Low-grade colon injuries
KW - primary repair
KW - resection with anastomosis
KW - trauma
UR - https://www.scopus.com/pages/publications/105007857993
UR - https://www.scopus.com/pages/publications/105007857993#tab=citedBy
U2 - 10.1097/TA.0000000000004649
DO - 10.1097/TA.0000000000004649
M3 - Article
C2 - 40474346
AN - SCOPUS:105007857993
SN - 2163-0755
VL - 99
SP - 105
EP - 112
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 1
ER -