Primary repair versus resection for American Association for the Surgery of Trauma grades I and II colon injuries: Does the management approach really matter? An Eastern Association for the Surgery of Trauma multicenter trial.
Background: The management of traumatic low-grade (American Association for the Surgery of Trauma [AAST] grades I and II) colon injuries has evolved. Recent data suggest that primary repair (PR) or resection over colostomy decreases morbidity and mortality. However, data comparing patients undergoing PR versus resection with anastomosis (RWA) are lacking. We hypothesized that patients presenting with low-grade colon injuries undergoing PR would have fewer postoperative complications than patients undergoing RWA.
Methods: This was a retrospective, multicenter analysis of all patients presenting with AAST grades I and II colon injuries to 32 Level 1 trauma centers from 2011 to 2021. Based on operative documentation, patients were dichotomized into two groups, those who underwent PR or RWA. Outcomes included length of stay, infectious complications, and mortality. Multivariate logistic regression was performed to determine the independent effect of operative technique on outcomes.
Results: A total of 2,022 patients met the inclusion criteria for this study. Most were young (36 [24-44] years), male (79.6%), and presented after penetrating trauma (58.2%). A total of 1,013 patients presented with a grade I injury, while 1,009 patients presented with a grade II injury. Furthermore, 1,314 patients underwent PR, and 708 underwent RWA. While there was no difference in Injury Severity Score between PR and RWA, RWA was associated with more adverse outcomes including surgical site infections, suture line failure/leak, fascial dehiscence, and a longer hospital length of stay (all p < 0.001). When controlling for mechanism of injury, AAST grade, Injury Severity Score, and number of intra-abdominal injuries RWA were independently associated with more infectious complications including superficial, deep, and organ space surgical site infections.
Conclusions: Resection with anastomosis was independently associated with more adverse outcomes including multiple infectious complications and longer hospital length of stay compared with PR, suggesting that low-grade colon injuries can be safely managed with PR alone. Methods: Multicenter Retrospective Comparative Study; Level III.