Sew it up! A Western XXXX Association multi-institutional study of enteric injury management in the postinjury open abdomen.

@entity1 @entity1944 @entity1457 @entity254 @entity292 @entity1320 @entity130
BACKGROUND: Use of damage control surgery techniques has reduced mortality in critically injured @entity1 but at the cost of the open abdomen. With the option of delayed definitive management of @entity130 , the question of intestinal repair/ @entity254 or definitive stoma creation has been posed with no clear consensus. The purpose of this study was to determine outcomes on the basis of management of @entity130 in @entity1 relegated to the postinjury open abdomen. METHODS: @entity1 requiring an open abdomen after @entity130 from January 1, 2002 to December 31, 2007 were reviewed. Type of bowel repair was categorized as immediate repair, immediate @entity254 , delayed @entity254 , stoma and a combination. Logistic regression was used to determine independent effect of risk factors on leak development. RESULTS: During the 6-year study period, 204 @entity1 suffered @entity130 and were managed with an open abdomen. The majority was @entity1 (77%) sustaining blunt @entity130 (66%) with a mean age of 37.1 years  1.2 years and median Injury Severity Score of 27 (interquartile range=20-41). Injury patterns included 81 (40%) small bowel, 37 (18%) colonic, and 86 (42%) combined injuries. Enteric injuries were managed with immediate repair (58), immediate @entity254 (15), delayed @entity254 (96), stoma (10), and a combination (22); three @entity1 died before definitive repair. Sixty-one @entity1 suffered @entity1320 : 35 (17%) abscesses, 15 (7%) leaks, and 11 (5%) enterocutaneous @entity292 . The majority of @entity1 with leaks had a delayed @entity254 ; one @entity1 had a right colon repair. Leak rate increased as one progresses toward the left colon (small bowel anastomoses, 3% leak rate; right colon, 3%; transverse colon, 20%; left colon, 45%). There were no differences in emergency department physiology, injury severity, transfusions, crystalloids, or demographic characteristics between @entity1 with and without leak. Leak cases had higher 12-hour heart rate (148 vs. 125, p=0.02) and higher 12-hour base deficit (13.7 vs. 9.7, p=0.04), suggesting persistent @entity1457 and consequent hypoperfusion were related to leak development. There was a significant trend toward higher incidence of leak with closure day (   for trend, p=0.01), with closure after day 5 having a four times higher likelihood of developing leak (3% vs. 12%, p=0.02). CONCLUSIONS: Repair or @entity254 of @entity1944 should be considered in all @entity1 . However, leak rate increases with fascial closure beyond day 5 and with left-sided colonic anastomoses. Investigating the physiologic basis for intestinal vulnerability of the left colon and in the open abdomen is warranted.
