Proximal protective diverting ostomy following colon anastomosis for penetrating trauma may not be protective: A matched cohort study

Joshua Dilday; Chih Ying Chien; Meghan R Lewis; Elizabeth R Benjamin; Demetrios Demetriades

doi:10.1016/j.amjsurg.2023.10.026

Proximal protective diverting ostomy following colon anastomosis for penetrating trauma may not be protective: A matched cohort study

Am J Surg. 2024 Feb:228:237-241. doi: 10.1016/j.amjsurg.2023.10.026. Epub 2023 Oct 13.

Authors

Joshua Dilday¹, Chih Ying Chien², Meghan R Lewis³, Elizabeth R Benjamin⁴, Demetrios Demetriades⁵

Affiliations

¹ Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: joshua.c.dilday@gmail.com.
² Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA; Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan. Electronic address: hjjiimm@gmail.com.
³ Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: meghan.lewis@med.usc.edu.
⁴ Department of Trauma and Surgical Critical Care, Grady Memorial Hospital, Atlanta, GA, USA. Electronic address: elizabeth.robinson.benjamin@emory.edu.
⁵ Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: Demetrios.Demetriades@med.usc.edu.

PMID: 37863797
DOI: 10.1016/j.amjsurg.2023.10.026

Abstract

Introduction: Despite the shift toward liberal primary anastomosis in penetrating colon injuries, some surgeons recommend a protective diverting ostomy (DO) proximal to the anastomosis. This study evaluates the effect of DO on outcomes in patients undergoing colon resection and anastomosis following penetrating trauma.

Methods: The TQIP database (2013-2018) was queried for penetrating colon injuries undergoing colectomy and anastomosis. Patients receiving DO were propensity matched to patients without diverting ostomy (woDO) (1:3). Outcomes were compared between groups.

Results: After matching, 89 DO patients were analyzed. The DO group had more surgical site infections (32 % vs. 21 %; p < 0.05) and longer hospital stay (20 [13-27] vs. 15 [9-25]; p < 0.05) compared to the woDO group. Mortality and unplanned operations were similar between groups.

Conclusions: Diverting ostomy after colon resection and anastomosis is associated with increased infectious complications without decreasing unplanned operations or mortality. Its routine role in penetrating colon trauma needs reassessment.

Keywords: Colon diversion; Colon trauma; Colostomy; Diverting ostomy.

MeSH terms

Anastomosis, Surgical
Cohort Studies
Colon / injuries
Colon / surgery
Colonic Diseases* / surgery
Colostomy
Humans
Ostomy*
Retrospective Studies
Wounds, Penetrating* / surgery