R. W. Beach1, R. A. Lawless1, M. K. McNutt1, L. J. Moore1, B. A. Cotton1, C. E. Wade1, J. B. Holcomb1, J. A. Harvin1 1University Of Texas Health Science Center At Houston,Acute Care Surgery,Houston, TX, USA
Introduction:
Enteric suture line failure (SLF) following colon resection in patient undergoing emergent trauma laparotomy is a morbid complication. Reported risk factors for SLF include the amount of red blood cells (RBCs) transfused, but vary in their inclusion of damage control laparotomy (DCL) patients. This report aims to determine risk factors associated with SLF that are available to the surgeon prior to the performance of anastomosis or stoma creation in patients undergoing both definitive laparotomy (DEF) and DCL.
Methods:
A retrospective review was performed of all patients ≥16 years of age admitted between 1/1/2011 and 3/31/2015 who underwent colon resection during emergent trauma laparotomy – defined as ED directly to OR or ED to IR to OR. Data was obtained from an institutional trauma registry and patient medical records. Patients who had stoma formation or died in intestinal discontinuity were excluded. On univariate analysis, patients undergoing DEF and DCL were analyzed separately comparing those who did and did not have SLF. A multiple logistic regression model was then created use variables determined a priori (age, post-operative vasopressor use, and RBCs) and those found to be clinically and significantly different.
Results:
A total of 19,506 patients were admitted during the study period, of which 871 underwent emergent laparotomy and 16% (142/871) had a colon resection. 29 had stoma placement and 6 died in intestinal discontinuity, leaving 107 patients having undergone anastomosis, 54 (50%) DEF and 53 (50%) DCL. In DEF group, 4 (7%) had SLF. Comparing those with and without SLF, no differences in demographics, Injury Severity Score (ISS), ED vital signs and resuscitation, or technique of anastomosis were seen. The patients with SLF had a lower final OR BE (median -9, IQR [-9, -4] versus -3, IQR [-4, -2], p=0.03) and a higher rate of postoperative vasopressor use (50% versus 4%, p=0.02). In the 53 DCL patients with an anastomosis, 8 (15%) patients had SLF. Comparing those with and without SLF, there were no differences in demographics, ISS, ED vital signs and resuscitation, OR vital signs and resuscitation, or postoperative vasopressor use. There was also no difference in indication for DCL, the use of intestinal discontinuity, or anastomotic technique. After adjusting for age, post-operative vasopressor use, OR RBCs, arrival SBP, arrival BE, ISS, and intestinal discontinuity, increasing age (OR 1.06, 95% CI 1.01-1.12, p=0.03) and intestinal discontinuity (OR 8.29, 95% CI 1.30-52.76, p=0.03) were independently associated with SLF.
Conclusion:
In patients undergoing definitive emergent trauma laparotomy with colectomy, SLF is an uncommon event, but appears associated with increased age and the degree of shock upon admission the OR. In patients undergoing damage control laparotomy with colectomy, SLF is associated with increased age and the utilization of intestinal discontinuity.