Vasopressor use after initial damage control laparotomy increases risk for anastomotic disruption in the management of destructive colon injuries

Peter Fischer, Andrew M. Nunn, Blair A. Wormer, A. Britton Christmas, Lindsay A. Gibeault, John M. Green, Ronald F. Sing

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background Management of destructive colon injuries during damage control (DC) laparotomy is debated. The authors reviewed a single institution's experience with destructive colon injuries to identify risk factors for anastomotic failure after colon reconstruction. Methods The authors identified all trauma patients sustaining destructive colon injuries between 2002 and 2011 from their medical center's trauma registry. Anastomotic leak was defined as suture or staple line disruption or enteral fistula formation. Results Of 171 identified patients, 68 had DC procedures, 41 (60%) had subsequent anastomoses performed during the same hospitalization, and 27 (40%) were diverted. The colon anastomotic leak rate in patients who underwent DC laparotomy was higher than in patients who were reconstructed at the primary operation in a non-DC setting (17% vs 6%, P =.09). The use of vasopressors after the initial DC operation more than quadrupled the leak rate to 50% (P =.02). Conclusions Colonic anastomotic disruptions yield deadly consequences, and diversion rather than anastomosis should be used in patients who require vasopressor support after the initial DC procedure.

Original languageEnglish (US)
Pages (from-to)900-903
Number of pages4
JournalAmerican Journal of Surgery
Volume206
Issue number6
DOIs
StatePublished - Dec 1 2013
Externally publishedYes

Fingerprint

Laparotomy
Colon
Wounds and Injuries
Anastomotic Leak
Trauma Centers
Sutures
Small Intestine
Fistula
Registries
Hospitalization

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Vasopressor use after initial damage control laparotomy increases risk for anastomotic disruption in the management of destructive colon injuries. / Fischer, Peter; Nunn, Andrew M.; Wormer, Blair A.; Christmas, A. Britton; Gibeault, Lindsay A.; Green, John M.; Sing, Ronald F.

In: American Journal of Surgery, Vol. 206, No. 6, 01.12.2013, p. 900-903.

Research output: Contribution to journalArticle

Fischer, Peter ; Nunn, Andrew M. ; Wormer, Blair A. ; Christmas, A. Britton ; Gibeault, Lindsay A. ; Green, John M. ; Sing, Ronald F. / Vasopressor use after initial damage control laparotomy increases risk for anastomotic disruption in the management of destructive colon injuries. In: American Journal of Surgery. 2013 ; Vol. 206, No. 6. pp. 900-903.
@article{2e12335bce5d4b018a59d2a86b13fbbd,
title = "Vasopressor use after initial damage control laparotomy increases risk for anastomotic disruption in the management of destructive colon injuries",
abstract = "Background Management of destructive colon injuries during damage control (DC) laparotomy is debated. The authors reviewed a single institution's experience with destructive colon injuries to identify risk factors for anastomotic failure after colon reconstruction. Methods The authors identified all trauma patients sustaining destructive colon injuries between 2002 and 2011 from their medical center's trauma registry. Anastomotic leak was defined as suture or staple line disruption or enteral fistula formation. Results Of 171 identified patients, 68 had DC procedures, 41 (60{\%}) had subsequent anastomoses performed during the same hospitalization, and 27 (40{\%}) were diverted. The colon anastomotic leak rate in patients who underwent DC laparotomy was higher than in patients who were reconstructed at the primary operation in a non-DC setting (17{\%} vs 6{\%}, P =.09). The use of vasopressors after the initial DC operation more than quadrupled the leak rate to 50{\%} (P =.02). Conclusions Colonic anastomotic disruptions yield deadly consequences, and diversion rather than anastomosis should be used in patients who require vasopressor support after the initial DC procedure.",
author = "Peter Fischer and Nunn, {Andrew M.} and Wormer, {Blair A.} and Christmas, {A. Britton} and Gibeault, {Lindsay A.} and Green, {John M.} and Sing, {Ronald F.}",
year = "2013",
month = "12",
day = "1",
doi = "10.1016/j.amjsurg.2013.07.034",
language = "English (US)",
volume = "206",
pages = "900--903",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Vasopressor use after initial damage control laparotomy increases risk for anastomotic disruption in the management of destructive colon injuries

AU - Fischer, Peter

AU - Nunn, Andrew M.

AU - Wormer, Blair A.

AU - Christmas, A. Britton

AU - Gibeault, Lindsay A.

AU - Green, John M.

AU - Sing, Ronald F.

PY - 2013/12/1

Y1 - 2013/12/1

N2 - Background Management of destructive colon injuries during damage control (DC) laparotomy is debated. The authors reviewed a single institution's experience with destructive colon injuries to identify risk factors for anastomotic failure after colon reconstruction. Methods The authors identified all trauma patients sustaining destructive colon injuries between 2002 and 2011 from their medical center's trauma registry. Anastomotic leak was defined as suture or staple line disruption or enteral fistula formation. Results Of 171 identified patients, 68 had DC procedures, 41 (60%) had subsequent anastomoses performed during the same hospitalization, and 27 (40%) were diverted. The colon anastomotic leak rate in patients who underwent DC laparotomy was higher than in patients who were reconstructed at the primary operation in a non-DC setting (17% vs 6%, P =.09). The use of vasopressors after the initial DC operation more than quadrupled the leak rate to 50% (P =.02). Conclusions Colonic anastomotic disruptions yield deadly consequences, and diversion rather than anastomosis should be used in patients who require vasopressor support after the initial DC procedure.

AB - Background Management of destructive colon injuries during damage control (DC) laparotomy is debated. The authors reviewed a single institution's experience with destructive colon injuries to identify risk factors for anastomotic failure after colon reconstruction. Methods The authors identified all trauma patients sustaining destructive colon injuries between 2002 and 2011 from their medical center's trauma registry. Anastomotic leak was defined as suture or staple line disruption or enteral fistula formation. Results Of 171 identified patients, 68 had DC procedures, 41 (60%) had subsequent anastomoses performed during the same hospitalization, and 27 (40%) were diverted. The colon anastomotic leak rate in patients who underwent DC laparotomy was higher than in patients who were reconstructed at the primary operation in a non-DC setting (17% vs 6%, P =.09). The use of vasopressors after the initial DC operation more than quadrupled the leak rate to 50% (P =.02). Conclusions Colonic anastomotic disruptions yield deadly consequences, and diversion rather than anastomosis should be used in patients who require vasopressor support after the initial DC procedure.

UR - http://www.scopus.com/inward/record.url?scp=84888984867&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84888984867&partnerID=8YFLogxK

U2 - 10.1016/j.amjsurg.2013.07.034

DO - 10.1016/j.amjsurg.2013.07.034

M3 - Article

VL - 206

SP - 900

EP - 903

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 6

ER -