RESHAPES

Increasing AAST EGS grade is associated with anastomosis type

Matthew C. Hernandez, Brandon R. Bruns, Nadeem N. Haddad, Margaret Lauerman, David S. Morris, Kristen Arnold, Herb A. Phelan, David Turay, Jason Murry, John Oh, Toby Enniss, Matthew M. Carrick, Thomas M. Scalea, Martin D. Zielinski

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

INTRODUCTION Threatened, perforated, and infarcted bowel is managed with conventional resection and anastomosis (hand sewn [HS] or stapled [ST]). The SHAPES analysis demonstrated equivalence between HS and ST techniques, yet surgeons appeared to prefer HS for the critically ill. We hypothesized that HS is more frequent in patients with higher disease severity as measured by the American Association for the Surgery of Trauma Emergency General Surgery (AAST EGS) grading system. METHODS We performed a post hoc analysis of the SHAPES database. Operative reports were submitted by volunteering SHAPES centers. Final AAST grade was compared with various outcomes including duration of stay, physiologic/laboratory data, anastomosis type, anastomosis failure (dehiscence, abscess, or fistula), and mortality. RESULTS A total of 391 patients were reviewed, with a mean age (±SD) of 61.2 ± 16.8 years, 47% women. Disease severity distribution was as follows: grade I (n = 0, 0%), grade II (n = 106, 27%), grade III (n = 113, 29%), grade IV (n = 123, 31%), and grade V (n = 49, 13%). Increasing AAST grade was associated with acidosis and hypothermia. There was an association between higher AAST grade and likelihood of HS anastomosis. On regression, factors associated with mortality included development of anastomosis complication and vasopressor use but not increasing AAST EGS grade or anastomotic technique. CONCLUSION This is the first study to use standardized anatomic injury grades for patients undergoing urgent/emergent bowel resection in EGS. Higher AAST severity scores are associated with key clinical outcomes in EGS diseases requiring bowel resection and anastomosis. Anastomotic-specific complications were not associated with higher AAST grade; however, mortality was influenced by anastomosis complication and vasopressor use. Future EGS studies should routinely include AAST grading as a method for reliable comparison of injury between groups. LEVEL OF EVIDENCE Prognostic, level III.

Original languageEnglish (US)
Pages (from-to)855-863
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume84
Issue number6
DOIs
StatePublished - Jun 1 2018

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Emergencies
Hand
Wounds and Injuries
Mortality
Acidosis
Hypothermia
Critical Illness
Abscess
Fistula
Databases

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Hernandez, M. C., Bruns, B. R., Haddad, N. N., Lauerman, M., Morris, D. S., Arnold, K., ... Zielinski, M. D. (2018). RESHAPES: Increasing AAST EGS grade is associated with anastomosis type. Journal of Trauma and Acute Care Surgery, 84(6), 855-863. https://doi.org/10.1097/TA.0000000000001864
Hernandez, Matthew C. ; Bruns, Brandon R. ; Haddad, Nadeem N. ; Lauerman, Margaret ; Morris, David S. ; Arnold, Kristen ; Phelan, Herb A. ; Turay, David ; Murry, Jason ; Oh, John ; Enniss, Toby ; Carrick, Matthew M. ; Scalea, Thomas M. ; Zielinski, Martin D. / RESHAPES : Increasing AAST EGS grade is associated with anastomosis type. In: Journal of Trauma and Acute Care Surgery. 2018 ; Vol. 84, No. 6. pp. 855-863.
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abstract = "INTRODUCTION Threatened, perforated, and infarcted bowel is managed with conventional resection and anastomosis (hand sewn [HS] or stapled [ST]). The SHAPES analysis demonstrated equivalence between HS and ST techniques, yet surgeons appeared to prefer HS for the critically ill. We hypothesized that HS is more frequent in patients with higher disease severity as measured by the American Association for the Surgery of Trauma Emergency General Surgery (AAST EGS) grading system. METHODS We performed a post hoc analysis of the SHAPES database. Operative reports were submitted by volunteering SHAPES centers. Final AAST grade was compared with various outcomes including duration of stay, physiologic/laboratory data, anastomosis type, anastomosis failure (dehiscence, abscess, or fistula), and mortality. RESULTS A total of 391 patients were reviewed, with a mean age (±SD) of 61.2 ± 16.8 years, 47{\%} women. Disease severity distribution was as follows: grade I (n = 0, 0{\%}), grade II (n = 106, 27{\%}), grade III (n = 113, 29{\%}), grade IV (n = 123, 31{\%}), and grade V (n = 49, 13{\%}). Increasing AAST grade was associated with acidosis and hypothermia. There was an association between higher AAST grade and likelihood of HS anastomosis. On regression, factors associated with mortality included development of anastomosis complication and vasopressor use but not increasing AAST EGS grade or anastomotic technique. CONCLUSION This is the first study to use standardized anatomic injury grades for patients undergoing urgent/emergent bowel resection in EGS. Higher AAST severity scores are associated with key clinical outcomes in EGS diseases requiring bowel resection and anastomosis. Anastomotic-specific complications were not associated with higher AAST grade; however, mortality was influenced by anastomosis complication and vasopressor use. Future EGS studies should routinely include AAST grading as a method for reliable comparison of injury between groups. LEVEL OF EVIDENCE Prognostic, level III.",
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Hernandez, MC, Bruns, BR, Haddad, NN, Lauerman, M, Morris, DS, Arnold, K, Phelan, HA, Turay, D, Murry, J, Oh, J, Enniss, T, Carrick, MM, Scalea, TM & Zielinski, MD 2018, 'RESHAPES: Increasing AAST EGS grade is associated with anastomosis type', Journal of Trauma and Acute Care Surgery, vol. 84, no. 6, pp. 855-863. https://doi.org/10.1097/TA.0000000000001864

RESHAPES : Increasing AAST EGS grade is associated with anastomosis type. / Hernandez, Matthew C.; Bruns, Brandon R.; Haddad, Nadeem N.; Lauerman, Margaret; Morris, David S.; Arnold, Kristen; Phelan, Herb A.; Turay, David; Murry, Jason; Oh, John; Enniss, Toby; Carrick, Matthew M.; Scalea, Thomas M.; Zielinski, Martin D.

In: Journal of Trauma and Acute Care Surgery, Vol. 84, No. 6, 01.06.2018, p. 855-863.

Research output: Contribution to journalArticle

TY - JOUR

T1 - RESHAPES

T2 - Increasing AAST EGS grade is associated with anastomosis type

AU - Hernandez, Matthew C.

AU - Bruns, Brandon R.

AU - Haddad, Nadeem N.

AU - Lauerman, Margaret

AU - Morris, David S.

AU - Arnold, Kristen

AU - Phelan, Herb A.

AU - Turay, David

AU - Murry, Jason

AU - Oh, John

AU - Enniss, Toby

AU - Carrick, Matthew M.

AU - Scalea, Thomas M.

AU - Zielinski, Martin D.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - INTRODUCTION Threatened, perforated, and infarcted bowel is managed with conventional resection and anastomosis (hand sewn [HS] or stapled [ST]). The SHAPES analysis demonstrated equivalence between HS and ST techniques, yet surgeons appeared to prefer HS for the critically ill. We hypothesized that HS is more frequent in patients with higher disease severity as measured by the American Association for the Surgery of Trauma Emergency General Surgery (AAST EGS) grading system. METHODS We performed a post hoc analysis of the SHAPES database. Operative reports were submitted by volunteering SHAPES centers. Final AAST grade was compared with various outcomes including duration of stay, physiologic/laboratory data, anastomosis type, anastomosis failure (dehiscence, abscess, or fistula), and mortality. RESULTS A total of 391 patients were reviewed, with a mean age (±SD) of 61.2 ± 16.8 years, 47% women. Disease severity distribution was as follows: grade I (n = 0, 0%), grade II (n = 106, 27%), grade III (n = 113, 29%), grade IV (n = 123, 31%), and grade V (n = 49, 13%). Increasing AAST grade was associated with acidosis and hypothermia. There was an association between higher AAST grade and likelihood of HS anastomosis. On regression, factors associated with mortality included development of anastomosis complication and vasopressor use but not increasing AAST EGS grade or anastomotic technique. CONCLUSION This is the first study to use standardized anatomic injury grades for patients undergoing urgent/emergent bowel resection in EGS. Higher AAST severity scores are associated with key clinical outcomes in EGS diseases requiring bowel resection and anastomosis. Anastomotic-specific complications were not associated with higher AAST grade; however, mortality was influenced by anastomosis complication and vasopressor use. Future EGS studies should routinely include AAST grading as a method for reliable comparison of injury between groups. LEVEL OF EVIDENCE Prognostic, level III.

AB - INTRODUCTION Threatened, perforated, and infarcted bowel is managed with conventional resection and anastomosis (hand sewn [HS] or stapled [ST]). The SHAPES analysis demonstrated equivalence between HS and ST techniques, yet surgeons appeared to prefer HS for the critically ill. We hypothesized that HS is more frequent in patients with higher disease severity as measured by the American Association for the Surgery of Trauma Emergency General Surgery (AAST EGS) grading system. METHODS We performed a post hoc analysis of the SHAPES database. Operative reports were submitted by volunteering SHAPES centers. Final AAST grade was compared with various outcomes including duration of stay, physiologic/laboratory data, anastomosis type, anastomosis failure (dehiscence, abscess, or fistula), and mortality. RESULTS A total of 391 patients were reviewed, with a mean age (±SD) of 61.2 ± 16.8 years, 47% women. Disease severity distribution was as follows: grade I (n = 0, 0%), grade II (n = 106, 27%), grade III (n = 113, 29%), grade IV (n = 123, 31%), and grade V (n = 49, 13%). Increasing AAST grade was associated with acidosis and hypothermia. There was an association between higher AAST grade and likelihood of HS anastomosis. On regression, factors associated with mortality included development of anastomosis complication and vasopressor use but not increasing AAST EGS grade or anastomotic technique. CONCLUSION This is the first study to use standardized anatomic injury grades for patients undergoing urgent/emergent bowel resection in EGS. Higher AAST severity scores are associated with key clinical outcomes in EGS diseases requiring bowel resection and anastomosis. Anastomotic-specific complications were not associated with higher AAST grade; however, mortality was influenced by anastomosis complication and vasopressor use. Future EGS studies should routinely include AAST grading as a method for reliable comparison of injury between groups. LEVEL OF EVIDENCE Prognostic, level III.

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Hernandez MC, Bruns BR, Haddad NN, Lauerman M, Morris DS, Arnold K et al. RESHAPES: Increasing AAST EGS grade is associated with anastomosis type. Journal of Trauma and Acute Care Surgery. 2018 Jun 1;84(6):855-863. https://doi.org/10.1097/TA.0000000000001864