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Deep organ space infection after emergency bowel resection and anastomosis: The anatomic site does not matter

Benjamin, Elizabeth MD, PhD; Siboni, Stefano MD; Haltmeier, Tobias MD; Inaba, Kenji MD; Lam, Lydia MD; Demetriades, Demetrios MD, PhD

Journal of Trauma and Acute Care Surgery: November 2015 - Volume 79 - Issue 5 - p 805–811
doi: 10.1097/TA.0000000000000840
Original Articles
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CME

BACKGROUND Deep organ space infection (DOSI) is a serious complication after emergency bowel resection and anastomosis. The aim of this study was to identify the incidence and risk factors for the development of DOSI.

METHODS National Surgical Quality Improvement Program database study including patients who underwent large bowel or small bowel resection and primary anastomosis. The incidence, outcomes, and risk factors for DOSI were evaluated using univariate and multivariate analyses.

RESULTS A total of 87,562 patients underwent small bowel, large bowel, or rectal resection and anastomosis. Of these, 14,942 (17.1%) underwent emergency operations and formed the study population. The overall mortality rate in emergency operations was 12.5%, and the rate of DOSI was 5.6%. A total of 18.0% required ventilatory support in more than 48 hours, and 16.0% required reoperation. Predictors of DOSI included age, steroid use, sepsis or septic shock on admission, severe wound contamination, and advanced American Society of Anesthesiologists classification. The anatomic location of resection and anastomosis was not significantly associated with DOSI.

CONCLUSION Patients undergoing emergency bowel resection and anastomosis have a high mortality, risk of DOSI, and systemic complications. Independent predictors of DOSI include wound and American Society of Anesthesiologists classification, sepsis or septic shock on admission, and steroid use. The anatomic location of resection and anastomosis was not significantly associated with DOSI.

LEVEL OF EVIDENCE Epidemiologic/prognostic study, level III.

From the Division of Trauma and Acute Care Surgery, Los Angeles County Medical Center, University of Southern California, Los Angeles, California.

Submitted: December 12, 2014; Revised: June 1, 2015; Accepted: June 3, 2015.

This article was presented at the American College of Surgeons 2014 meeting as a poster.

Address for reprints: Elizabeth Benjamin, MD, PhD, LAC + USC Medical Center, 2051 Marengo St, Inpatient Tower C5L-100, Los Angeles, CA 90033; email: Elizabeth.Benjamin@med.usc.edu.

© 2015 Lippincott Williams & Wilkins, Inc.