Colon injuries in the presence of complete spinal cord injury: Primary repair or colostomy?

IF 2.7 3区医学 Q1 SURGERY American journal of surgery Pub Date : 2025-04-01 Epub Date: 2025-01-30 DOI:10.1016/j.amjsurg.2025.116225

Wei Huang , Caitlyn Braschi , Natalie Hodges , Yu Cheng Chiu , Demetrios Demetriades

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Abstract

Background

Complete spinal cord injury (SCI) is associated with severe colon dysmotility and therefore may be associated with higher risk of leak following primary repair or anastomosis for concomitant colon injury.

Methods

TQIP database study, patients with complete SCI and associated colon injuries who underwent primary repair (PR) or resection with primary anastomosis (RPA) were compared to those who underwent ostomy alone using propensity score matching.

Results

Ninety-nine patients treated with a colostomy were matched with 215 treated with PR or RPA. Patients treated with colostomy were more likely to develop severe sepsis post-operatively (13.1 % vs 4.2 %, p = 0.004). Subgroup analysis, comparing colostomy versus PR or colostomy versus RPA, showed again a higher incidence of postoperative severe sepsis in the colostomy group.

Conclusions

Primary repair and/or RPA are associated with a lower incidence of postoperative severe sepsis than colostomy and should be considered in patients with combined SCI and colon injury.

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完全性脊髓损伤并发结肠损伤：初级修复还是结肠造口术？

背景：完全性脊髓损伤（SCI）与严重的结肠运动障碍有关，因此可能与结肠损伤初级修复或吻合后泄漏的高风险相关。方法通过stqip数据库研究，将完全性脊髓损伤合并结肠损伤行一期修复（PR）或一期吻合切除（RPA）的患者与单纯行造口术的患者进行倾向评分匹配。结果99例采用结肠造口术，215例采用PR或RPA。接受结肠造口治疗的患者术后更容易发生严重脓毒症（13.1% vs 4.2%, p = 0.004）。亚组分析，比较结肠造口术与PR或结肠造口术与RPA，再次显示结肠造口术组术后严重脓毒症的发生率更高。结论与结肠造口术相比，初次修复和/或RPA术后严重脓毒症的发生率较低，在脊髓损伤合并结肠损伤患者中应予以考虑。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.