B R Bruns1, J DuBose2, J Pasley3, T Kheirbek4, K Chouliaras5, A Riggle6, M K Frank7, H A Phelan8, D Holena9, K Inaba10, J Diaz11, T M Scalea12. 1. R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St S4D07, Baltimore, MD, 21201, USA. Bbruns@umm.edu. 2. The University of Texas Health Science Center, Houston, TX, USA. Joseph.J.DuBose@uth.tmc.edu. 3. R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St S4D07, Baltimore, MD, 21201, USA. Jpasley@umm.edu. 4. Division of Traumatology, Emergency Surgery and Surgical Critical Care, University of Pennsylvania, Philadelphia, PA, USA. Tareq.Kheirbek@uphs.upenn.edu. 5. Department of Surgery, University of Southern California, Los Angeles, CA, USA. Chouliar@usc.edu. 6. Parkland Memorial Hospital, The University of Texas Southwestern, Dallas, TX, USA. Andrew.Riggle@phhs.org. 7. R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St S4D07, Baltimore, MD, 21201, USA. Mfrank@stapa.umm.edu. 8. Parkland Memorial Hospital, The University of Texas Southwestern, Dallas, TX, USA. Herb.Phelan@UTSouthwestern.edu. 9. Division of Traumatology, Emergency Surgery and Surgical Critical Care, University of Pennsylvania, Philadelphia, PA, USA. Daniel.Holena@uphs.upenn.edu. 10. Department of Surgery, University of Southern California, Los Angeles, CA, USA. Kenji.Inaba@med.usc.edu. 11. R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St S4D07, Baltimore, MD, 21201, USA. Jdiaz@umm.edu. 12. R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St S4D07, Baltimore, MD, 21201, USA. Tscalea@umm.edu.
Abstract
PURPOSE: Though primary repair of colon injuries is preferred, certain injury patterns require colostomy creation. Colostomy reversal is associated with significant morbidity and healthcare cost. Complication rates may be influenced by technique of diversion (loop vs. end colostomy), though this remains ill-defined. We hypothesized that reversal of loop colostomies is associated with fewer complications than end colostomies. METHODS: This is a retrospective, multi-institutional study (four, level-1 trauma centers) of patients undergoing colostomy takedown for trauma during the time period 1/2006-12/2012. Data were collected from index trauma admission and subsequent admission for reversal and included demographics and complications of reversal. Student's t test was used to compare continuous variables against loop versus end colostomy. Discrete variables were compared against both groups using Chi-squared tests. RESULTS: Over the 6-year study period, 218 patients underwent colostomy takedown after trauma with a mean age of 30; 190 (87%) were male, 162 (74%) had penetrating injury as their indication for colostomy, and 98 (45%) experienced at least one complication. Patients in the end colostomy group (n = 160) were more likely to require midline laparotomy (145 vs. 18, p < 0.001), had greater intra-operative blood loss (260.7 vs. 99.4 mL, p < 0.001), had greater hospital length of stay (8.4 vs. 5.5 days, p < 0.001), and had more overall complications (81 vs. 17, p = 0.005) than patients managed with loop colostomy (n = 58). CONCLUSIONS: Local takedown of a loop colostomy is safe and leads to shorter hospital stays, less intra-operative blood loss, and fewer complications when compared to end colostomy.
PURPOSE: Though primary repair of colon injuries is preferred, certain injury patterns require colostomy creation. Colostomy reversal is associated with significant morbidity and healthcare cost. Complication rates may be influenced by technique of diversion (loop vs. end colostomy), though this remains ill-defined. We hypothesized that reversal of loop colostomies is associated with fewer complications than end colostomies. METHODS: This is a retrospective, multi-institutional study (four, level-1 trauma centers) of patients undergoing colostomy takedown for trauma during the time period 1/2006-12/2012. Data were collected from index trauma admission and subsequent admission for reversal and included demographics and complications of reversal. Student's t test was used to compare continuous variables against loop versus end colostomy. Discrete variables were compared against both groups using Chi-squared tests. RESULTS: Over the 6-year study period, 218 patients underwent colostomy takedown after trauma with a mean age of 30; 190 (87%) were male, 162 (74%) had penetrating injury as their indication for colostomy, and 98 (45%) experienced at least one complication. Patients in the end colostomy group (n = 160) were more likely to require midline laparotomy (145 vs. 18, p < 0.001), had greater intra-operative blood loss (260.7 vs. 99.4 mL, p < 0.001), had greater hospital length of stay (8.4 vs. 5.5 days, p < 0.001), and had more overall complications (81 vs. 17, p = 0.005) than patients managed with loop colostomy (n = 58). CONCLUSIONS: Local takedown of a loop colostomy is safe and leads to shorter hospital stays, less intra-operative blood loss, and fewer complications when compared to end colostomy.
Authors: F Ferrara; D Parini; A Bondurri; M Veltri; M Barbierato; F Pata; F Cattaneo; A Tafuri; C Forni; G Roveron; G Rizzo Journal: Tech Coloproctol Date: 2019-10-12 Impact factor: 3.781
Authors: 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 Catalano; Georgia 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 Journal: J Trauma Acute Care Surg Date: 2020-12 Impact factor: 3.697