R. A. Fonseca1, J. A. Aldana1, J. E. Rincon1, R. K. Rasane1, C. X. Zhang1, Q. Zhang1, J. McMullen1, M. Sorini1, K. M. Bochicchio1, O. N. Ilahi1, G. V. Bochicchio1 1Washington University,Surgery,St. Louis, MO, USA
Introduction: Colonic perforations (CP) are frequently found in trauma and acute care emergency surgery (ACES) patients. While there is abundant literature regarding CP and surgically-related complications (SRC), to our knowledge, there are no studies comparing the outcome of CP between these patient populations. We hypothesize that ACES patients with pathological CP have a significantly greater number of SRC and worse outcome compared to trauma patients.
Methods: Patients with ICD 9/10 code for CP were retrospectively reviewed from our trauma and ACES database from 2005 to 2018. For the trauma cohort, all patients with a non-abdominal region abbreviated injury score ≥2 were excluded. Demographics, comorbidities, clinical outcomes [hospital length of stay (LOS), and intensive care unit (ICU) LOS], SRC [anastomotic leak, intra-abdominal abscess (IAA), fascial dehiscence and deep wound infection], cultures and mortality were compared between cohorts.
Results: The study consisted of 212 trauma and 100 ACES cases of CP (312 total patients). Trauma patients were likely to be males (p<.001). ACES patients were significantly older [p?.001] and had a higher Charlson Comorbidity Index (CCI) [p?.001]. In outcomes, hospital LOS [p?.001], ICU LOS [p?.001] and mortality [p?.001] was higher in ACES patients. The most common organism cultured from IAA was Bacteroides fragilis for both groups. No significant differences were found when comparing SRC in ACES vs trauma patients. Controlling for age, BMI, gender and CCI, mortality between cohorts was not significantly different (p=.053).
Conclusion: Contrary to our hypothesis, trauma, and ACES patients have similar SRC. The worse outcome in ACES patients with CP was most likely related to a greater number of comorbidities. Surgeons should be more alert about the need for aggressive medical treatment for ACES patients with CP.
