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


CONCLUSIONS
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.


METHODS
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.
Elizabeth
E
Benjamin
Stefano
S
Siboni
Tobias
T
Haltmeier
Kenji
K
Inaba
Lydia
L
Lam
Demetrios
D
Demetriades
D034841:Abdominal Cavity / Q000382:microbiology / Q000503:physiopathology; D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000382:microbiology / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D004638:Emergency Treatment / Q000379:methods / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000382:microbiology / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome