Impact of location on outcome after penetrating colon injuries

John P. Sharpe, Louis J. Magnotti, Jordan A. Weinberg, Ben L. Zarzaur, Charles P. Shahan, Nancy A. Parks, Timothy Fabian, Martin Croce

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND: Most studies examining suture line failure after penetrating colon injuries have focused on right- versus left-sided injuries. In our institution, operative decisions (resection plus anastomosis vs. diversion) are based on a defined management algorithm regardless of injury location. The purpose of this study was to evaluate the effect of injury location on outcomes after penetrating colon injuries. METHODS: Consecutive patients with full thickness penetrating colon injuries for 13 years were stratified by age, injury location and mechanism, and severity of shock. According to the algorithm, patients with nondestructive injuries underwent primary repair. Destructive wounds underwent resection plus anastomosis in the absence of comorbidities or large preoperative or intraoperative transfusion requirements (>6 U of packed red blood cells); otherwise, they were diverted. Injury location was defined as ascending, transverse, descending (including splenic flexure), and sigmoid. Multivariable logistic regression was performed to determine whether injury location was an independent predictor of either morbidity or mortality. RESULTS: Four hundred sixty-nine patients were identified: 314 (67%) underwent primary repair and 155 (33%) underwent resection. Most injuries involved the transverse colon (39%), followed by the ascending colon (26%), the descending colon (21%), and the sigmoid colon (14%). Overall, there were 13 suture line failures (3%) and 72 abscesses (15%). Most suture line failures involved injuries to the descending colon (p = 0.06), whereas most abscesses followed injuries to the ascending colon (p = 0.37). Multivariable logistic regression failed to identify injury location as an independent predictor of either morbidity or mortality after adjusting for 24-hour transfusions, base excess, shock index, injury mechanism, and operative management. CONCLUSION: Injury location did not affect morbidity or mortality after penetrating colon injuries. Nondestructive injuries should be primarily repaired. For destructive injuries, operative decisions based on a defined algorithm rather than injury location achieves an acceptably low morbidity and mortality rate and simplifies management. LEVEL OF EVIDENCE: Prognostic study, level III.

Original languageEnglish (US)
Pages (from-to)1428-1432
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume73
Issue number6
DOIs
StatePublished - Dec 1 2012

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Colon
Wounds and Injuries
Sutures
Morbidity
Descending Colon
Ascending Colon
Transverse Colon
Mortality
Sigmoid Colon
Abscess
Shock
Logistic Models
Comorbidity

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Sharpe, J. P., Magnotti, L. J., Weinberg, J. A., Zarzaur, B. L., Shahan, C. P., Parks, N. A., ... Croce, M. (2012). Impact of location on outcome after penetrating colon injuries. Journal of Trauma and Acute Care Surgery, 73(6), 1428-1432. https://doi.org/10.1097/TA.0b013e31825bff06

Impact of location on outcome after penetrating colon injuries. / Sharpe, John P.; Magnotti, Louis J.; Weinberg, Jordan A.; Zarzaur, Ben L.; Shahan, Charles P.; Parks, Nancy A.; Fabian, Timothy; Croce, Martin.

In: Journal of Trauma and Acute Care Surgery, Vol. 73, No. 6, 01.12.2012, p. 1428-1432.

Research output: Contribution to journalArticle

Sharpe, JP, Magnotti, LJ, Weinberg, JA, Zarzaur, BL, Shahan, CP, Parks, NA, Fabian, T & Croce, M 2012, 'Impact of location on outcome after penetrating colon injuries', Journal of Trauma and Acute Care Surgery, vol. 73, no. 6, pp. 1428-1432. https://doi.org/10.1097/TA.0b013e31825bff06
Sharpe JP, Magnotti LJ, Weinberg JA, Zarzaur BL, Shahan CP, Parks NA et al. Impact of location on outcome after penetrating colon injuries. Journal of Trauma and Acute Care Surgery. 2012 Dec 1;73(6):1428-1432. https://doi.org/10.1097/TA.0b013e31825bff06
Sharpe, John P. ; Magnotti, Louis J. ; Weinberg, Jordan A. ; Zarzaur, Ben L. ; Shahan, Charles P. ; Parks, Nancy A. ; Fabian, Timothy ; Croce, Martin. / Impact of location on outcome after penetrating colon injuries. In: Journal of Trauma and Acute Care Surgery. 2012 ; Vol. 73, No. 6. pp. 1428-1432.
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abstract = "BACKGROUND: Most studies examining suture line failure after penetrating colon injuries have focused on right- versus left-sided injuries. In our institution, operative decisions (resection plus anastomosis vs. diversion) are based on a defined management algorithm regardless of injury location. The purpose of this study was to evaluate the effect of injury location on outcomes after penetrating colon injuries. METHODS: Consecutive patients with full thickness penetrating colon injuries for 13 years were stratified by age, injury location and mechanism, and severity of shock. According to the algorithm, patients with nondestructive injuries underwent primary repair. Destructive wounds underwent resection plus anastomosis in the absence of comorbidities or large preoperative or intraoperative transfusion requirements (>6 U of packed red blood cells); otherwise, they were diverted. Injury location was defined as ascending, transverse, descending (including splenic flexure), and sigmoid. Multivariable logistic regression was performed to determine whether injury location was an independent predictor of either morbidity or mortality. RESULTS: Four hundred sixty-nine patients were identified: 314 (67{\%}) underwent primary repair and 155 (33{\%}) underwent resection. Most injuries involved the transverse colon (39{\%}), followed by the ascending colon (26{\%}), the descending colon (21{\%}), and the sigmoid colon (14{\%}). Overall, there were 13 suture line failures (3{\%}) and 72 abscesses (15{\%}). Most suture line failures involved injuries to the descending colon (p = 0.06), whereas most abscesses followed injuries to the ascending colon (p = 0.37). Multivariable logistic regression failed to identify injury location as an independent predictor of either morbidity or mortality after adjusting for 24-hour transfusions, base excess, shock index, injury mechanism, and operative management. CONCLUSION: Injury location did not affect morbidity or mortality after penetrating colon injuries. Nondestructive injuries should be primarily repaired. For destructive injuries, operative decisions based on a defined algorithm rather than injury location achieves an acceptably low morbidity and mortality rate and simplifies management. LEVEL OF EVIDENCE: Prognostic study, level III.",
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N2 - BACKGROUND: Most studies examining suture line failure after penetrating colon injuries have focused on right- versus left-sided injuries. In our institution, operative decisions (resection plus anastomosis vs. diversion) are based on a defined management algorithm regardless of injury location. The purpose of this study was to evaluate the effect of injury location on outcomes after penetrating colon injuries. METHODS: Consecutive patients with full thickness penetrating colon injuries for 13 years were stratified by age, injury location and mechanism, and severity of shock. According to the algorithm, patients with nondestructive injuries underwent primary repair. Destructive wounds underwent resection plus anastomosis in the absence of comorbidities or large preoperative or intraoperative transfusion requirements (>6 U of packed red blood cells); otherwise, they were diverted. Injury location was defined as ascending, transverse, descending (including splenic flexure), and sigmoid. Multivariable logistic regression was performed to determine whether injury location was an independent predictor of either morbidity or mortality. RESULTS: Four hundred sixty-nine patients were identified: 314 (67%) underwent primary repair and 155 (33%) underwent resection. Most injuries involved the transverse colon (39%), followed by the ascending colon (26%), the descending colon (21%), and the sigmoid colon (14%). Overall, there were 13 suture line failures (3%) and 72 abscesses (15%). Most suture line failures involved injuries to the descending colon (p = 0.06), whereas most abscesses followed injuries to the ascending colon (p = 0.37). Multivariable logistic regression failed to identify injury location as an independent predictor of either morbidity or mortality after adjusting for 24-hour transfusions, base excess, shock index, injury mechanism, and operative management. CONCLUSION: Injury location did not affect morbidity or mortality after penetrating colon injuries. Nondestructive injuries should be primarily repaired. For destructive injuries, operative decisions based on a defined algorithm rather than injury location achieves an acceptably low morbidity and mortality rate and simplifies management. LEVEL OF EVIDENCE: Prognostic study, level III.

AB - BACKGROUND: Most studies examining suture line failure after penetrating colon injuries have focused on right- versus left-sided injuries. In our institution, operative decisions (resection plus anastomosis vs. diversion) are based on a defined management algorithm regardless of injury location. The purpose of this study was to evaluate the effect of injury location on outcomes after penetrating colon injuries. METHODS: Consecutive patients with full thickness penetrating colon injuries for 13 years were stratified by age, injury location and mechanism, and severity of shock. According to the algorithm, patients with nondestructive injuries underwent primary repair. Destructive wounds underwent resection plus anastomosis in the absence of comorbidities or large preoperative or intraoperative transfusion requirements (>6 U of packed red blood cells); otherwise, they were diverted. Injury location was defined as ascending, transverse, descending (including splenic flexure), and sigmoid. Multivariable logistic regression was performed to determine whether injury location was an independent predictor of either morbidity or mortality. RESULTS: Four hundred sixty-nine patients were identified: 314 (67%) underwent primary repair and 155 (33%) underwent resection. Most injuries involved the transverse colon (39%), followed by the ascending colon (26%), the descending colon (21%), and the sigmoid colon (14%). Overall, there were 13 suture line failures (3%) and 72 abscesses (15%). Most suture line failures involved injuries to the descending colon (p = 0.06), whereas most abscesses followed injuries to the ascending colon (p = 0.37). Multivariable logistic regression failed to identify injury location as an independent predictor of either morbidity or mortality after adjusting for 24-hour transfusions, base excess, shock index, injury mechanism, and operative management. CONCLUSION: Injury location did not affect morbidity or mortality after penetrating colon injuries. Nondestructive injuries should be primarily repaired. For destructive injuries, operative decisions based on a defined algorithm rather than injury location achieves an acceptably low morbidity and mortality rate and simplifies management. LEVEL OF EVIDENCE: Prognostic study, level III.

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