Stapled versus hand-sewn: A prospective emergency surgery study. An American Association for the Surgery of Trauma multi-institutional study

Brandon Robert Bruns, David S. Morris, Martin Zielinski, Nathan T. Mowery, Preston R. Miller, Kristen Arnold, Herb A. Phelan, Jason Murry, David Turay, John Fam, John Oh, Oliver L. Gunter, Toby Enniss, Joseph D. Love, David Skarupa, Matthew Benns, Alisan Fathalizadeh, Pak Shan Leung, Matthew M. Carrick, Brent JewettJoseph Sakran, Lindsay O'Meara, Anthony V. Herrera, Hegang Chen, Thomas M. Scalea, Jose J. Diaz

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Data from the trauma patient population suggests handsewn (HS) anastomoses are superior to stapled (ST). A recent retrospective study in emergency general surgery (EGS) patients had similar findings. The aim of the current study was to evaluate HS and ST anastomoses in EGS patients undergoing urgent/emergent operations. Methods: The study was sponsored by the American Association for the Surgery of Trauma Multi-Institutional Studies Committee. Patients undergoing urgent/emergent bowel resection for EGS pathology were prospectively enrolled from July 22, 2013 to December 31, 2015. Patients were grouped by HS/ST anastomoses, and variables were collected. The primary outcome was anastomotic failure. Similar to other studies, anastomotic failure was evaluated at the anastomosis level. Multivariable logistic regression was performed controlling for age and risk factors for anastomotic failure. Results: Fifteen institutions enrolled a total of 595 patients with 649 anastomoses (253 HS and 396 ST). Mean age was 61 years, 51% were men, 7% overall mortality. Age and sex were the same between groups. The overall anastomotic failure rate was 12.5%. The HS group had higher lactate, lower albumin, and were more likely to be on vasopressors. Hospital and intensive care unit days, as well as mortality, were greater in the HS group. Anastomotic failure rates and operative time were equivalent for HS and ST. On multivariate regression, the presence of contamination at initial resection (odds ratio, 1.965; 95% confidence interval, 1.183-3.264) and the patient being managed with open abdomen (odds ratio, 2.529; 95% confidence interval, 1.492-4.286) were independently associated with anastomotic failure, while the type of anastomosis was not. Conclusion: EGS patients requiring bowel resection and anastomosis are at high risk for anastomotic failure. The current study illustrates an apparent bias among acute care surgeons to perform HS techniques in higher-risk patients. Despite the individualized application of technique for differing patient populations, the risk of anastomotic failure was equivalent when comparing HS and ST anastomoses. Level of Evidence: Therapeutic study, level II.

Original languageEnglish (US)
Pages (from-to)435-443
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume82
Issue number3
DOIs
StatePublished - Mar 1 2017

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Emergencies
Hand
Wounds and Injuries
Odds Ratio
Confidence Intervals
Mortality
Age Factors
Operative Time
Abdomen
Population
Intensive Care Units
Albumins
Lactic Acid
Retrospective Studies
Logistic Models
Pathology

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Bruns, Brandon Robert ; Morris, David S. ; Zielinski, Martin ; Mowery, Nathan T. ; Miller, Preston R. ; Arnold, Kristen ; Phelan, Herb A. ; Murry, Jason ; Turay, David ; Fam, John ; Oh, John ; Gunter, Oliver L. ; Enniss, Toby ; Love, Joseph D. ; Skarupa, David ; Benns, Matthew ; Fathalizadeh, Alisan ; Leung, Pak Shan ; Carrick, Matthew M. ; Jewett, Brent ; Sakran, Joseph ; O'Meara, Lindsay ; Herrera, Anthony V. ; Chen, Hegang ; Scalea, Thomas M. ; Diaz, Jose J. / Stapled versus hand-sewn : A prospective emergency surgery study. An American Association for the Surgery of Trauma multi-institutional study. In: Journal of Trauma and Acute Care Surgery. 2017 ; Vol. 82, No. 3. pp. 435-443.
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abstract = "Background: Data from the trauma patient population suggests handsewn (HS) anastomoses are superior to stapled (ST). A recent retrospective study in emergency general surgery (EGS) patients had similar findings. The aim of the current study was to evaluate HS and ST anastomoses in EGS patients undergoing urgent/emergent operations. Methods: The study was sponsored by the American Association for the Surgery of Trauma Multi-Institutional Studies Committee. Patients undergoing urgent/emergent bowel resection for EGS pathology were prospectively enrolled from July 22, 2013 to December 31, 2015. Patients were grouped by HS/ST anastomoses, and variables were collected. The primary outcome was anastomotic failure. Similar to other studies, anastomotic failure was evaluated at the anastomosis level. Multivariable logistic regression was performed controlling for age and risk factors for anastomotic failure. Results: Fifteen institutions enrolled a total of 595 patients with 649 anastomoses (253 HS and 396 ST). Mean age was 61 years, 51{\%} were men, 7{\%} overall mortality. Age and sex were the same between groups. The overall anastomotic failure rate was 12.5{\%}. The HS group had higher lactate, lower albumin, and were more likely to be on vasopressors. Hospital and intensive care unit days, as well as mortality, were greater in the HS group. Anastomotic failure rates and operative time were equivalent for HS and ST. On multivariate regression, the presence of contamination at initial resection (odds ratio, 1.965; 95{\%} confidence interval, 1.183-3.264) and the patient being managed with open abdomen (odds ratio, 2.529; 95{\%} confidence interval, 1.492-4.286) were independently associated with anastomotic failure, while the type of anastomosis was not. Conclusion: EGS patients requiring bowel resection and anastomosis are at high risk for anastomotic failure. The current study illustrates an apparent bias among acute care surgeons to perform HS techniques in higher-risk patients. Despite the individualized application of technique for differing patient populations, the risk of anastomotic failure was equivalent when comparing HS and ST anastomoses. Level of Evidence: Therapeutic study, level II.",
author = "Bruns, {Brandon Robert} and Morris, {David S.} and Martin Zielinski and Mowery, {Nathan T.} and Miller, {Preston R.} and Kristen Arnold and Phelan, {Herb A.} and Jason Murry and David Turay and John Fam and John Oh and Gunter, {Oliver L.} and Toby Enniss and Love, {Joseph D.} and David Skarupa and Matthew Benns and Alisan Fathalizadeh and Leung, {Pak Shan} and Carrick, {Matthew M.} and Brent Jewett and Joseph Sakran and Lindsay O'Meara and Herrera, {Anthony V.} and Hegang Chen and Scalea, {Thomas M.} and Diaz, {Jose J.}",
year = "2017",
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language = "English (US)",
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pages = "435--443",
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Bruns, BR, Morris, DS, Zielinski, M, Mowery, NT, Miller, PR, Arnold, K, Phelan, HA, Murry, J, Turay, D, Fam, J, Oh, J, Gunter, OL, Enniss, T, Love, JD, Skarupa, D, Benns, M, Fathalizadeh, A, Leung, PS, Carrick, MM, Jewett, B, Sakran, J, O'Meara, L, Herrera, AV, Chen, H, Scalea, TM & Diaz, JJ 2017, 'Stapled versus hand-sewn: A prospective emergency surgery study. An American Association for the Surgery of Trauma multi-institutional study', Journal of Trauma and Acute Care Surgery, vol. 82, no. 3, pp. 435-443. https://doi.org/10.1097/TA.0000000000001354

Stapled versus hand-sewn : A prospective emergency surgery study. An American Association for the Surgery of Trauma multi-institutional study. / Bruns, Brandon Robert; Morris, David S.; Zielinski, Martin; Mowery, Nathan T.; Miller, Preston R.; Arnold, Kristen; Phelan, Herb A.; Murry, Jason; Turay, David; Fam, John; Oh, John; Gunter, Oliver L.; Enniss, Toby; Love, Joseph D.; Skarupa, David; Benns, Matthew; Fathalizadeh, Alisan; Leung, Pak Shan; Carrick, Matthew M.; Jewett, Brent; Sakran, Joseph; O'Meara, Lindsay; Herrera, Anthony V.; Chen, Hegang; Scalea, Thomas M.; Diaz, Jose J.

In: Journal of Trauma and Acute Care Surgery, Vol. 82, No. 3, 01.03.2017, p. 435-443.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Stapled versus hand-sewn

T2 - A prospective emergency surgery study. An American Association for the Surgery of Trauma multi-institutional study

AU - Bruns, Brandon Robert

AU - Morris, David S.

AU - Zielinski, Martin

AU - Mowery, Nathan T.

AU - Miller, Preston R.

AU - Arnold, Kristen

AU - Phelan, Herb A.

AU - Murry, Jason

AU - Turay, David

AU - Fam, John

AU - Oh, John

AU - Gunter, Oliver L.

AU - Enniss, Toby

AU - Love, Joseph D.

AU - Skarupa, David

AU - Benns, Matthew

AU - Fathalizadeh, Alisan

AU - Leung, Pak Shan

AU - Carrick, Matthew M.

AU - Jewett, Brent

AU - Sakran, Joseph

AU - O'Meara, Lindsay

AU - Herrera, Anthony V.

AU - Chen, Hegang

AU - Scalea, Thomas M.

AU - Diaz, Jose J.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background: Data from the trauma patient population suggests handsewn (HS) anastomoses are superior to stapled (ST). A recent retrospective study in emergency general surgery (EGS) patients had similar findings. The aim of the current study was to evaluate HS and ST anastomoses in EGS patients undergoing urgent/emergent operations. Methods: The study was sponsored by the American Association for the Surgery of Trauma Multi-Institutional Studies Committee. Patients undergoing urgent/emergent bowel resection for EGS pathology were prospectively enrolled from July 22, 2013 to December 31, 2015. Patients were grouped by HS/ST anastomoses, and variables were collected. The primary outcome was anastomotic failure. Similar to other studies, anastomotic failure was evaluated at the anastomosis level. Multivariable logistic regression was performed controlling for age and risk factors for anastomotic failure. Results: Fifteen institutions enrolled a total of 595 patients with 649 anastomoses (253 HS and 396 ST). Mean age was 61 years, 51% were men, 7% overall mortality. Age and sex were the same between groups. The overall anastomotic failure rate was 12.5%. The HS group had higher lactate, lower albumin, and were more likely to be on vasopressors. Hospital and intensive care unit days, as well as mortality, were greater in the HS group. Anastomotic failure rates and operative time were equivalent for HS and ST. On multivariate regression, the presence of contamination at initial resection (odds ratio, 1.965; 95% confidence interval, 1.183-3.264) and the patient being managed with open abdomen (odds ratio, 2.529; 95% confidence interval, 1.492-4.286) were independently associated with anastomotic failure, while the type of anastomosis was not. Conclusion: EGS patients requiring bowel resection and anastomosis are at high risk for anastomotic failure. The current study illustrates an apparent bias among acute care surgeons to perform HS techniques in higher-risk patients. Despite the individualized application of technique for differing patient populations, the risk of anastomotic failure was equivalent when comparing HS and ST anastomoses. Level of Evidence: Therapeutic study, level II.

AB - Background: Data from the trauma patient population suggests handsewn (HS) anastomoses are superior to stapled (ST). A recent retrospective study in emergency general surgery (EGS) patients had similar findings. The aim of the current study was to evaluate HS and ST anastomoses in EGS patients undergoing urgent/emergent operations. Methods: The study was sponsored by the American Association for the Surgery of Trauma Multi-Institutional Studies Committee. Patients undergoing urgent/emergent bowel resection for EGS pathology were prospectively enrolled from July 22, 2013 to December 31, 2015. Patients were grouped by HS/ST anastomoses, and variables were collected. The primary outcome was anastomotic failure. Similar to other studies, anastomotic failure was evaluated at the anastomosis level. Multivariable logistic regression was performed controlling for age and risk factors for anastomotic failure. Results: Fifteen institutions enrolled a total of 595 patients with 649 anastomoses (253 HS and 396 ST). Mean age was 61 years, 51% were men, 7% overall mortality. Age and sex were the same between groups. The overall anastomotic failure rate was 12.5%. The HS group had higher lactate, lower albumin, and were more likely to be on vasopressors. Hospital and intensive care unit days, as well as mortality, were greater in the HS group. Anastomotic failure rates and operative time were equivalent for HS and ST. On multivariate regression, the presence of contamination at initial resection (odds ratio, 1.965; 95% confidence interval, 1.183-3.264) and the patient being managed with open abdomen (odds ratio, 2.529; 95% confidence interval, 1.492-4.286) were independently associated with anastomotic failure, while the type of anastomosis was not. Conclusion: EGS patients requiring bowel resection and anastomosis are at high risk for anastomotic failure. The current study illustrates an apparent bias among acute care surgeons to perform HS techniques in higher-risk patients. Despite the individualized application of technique for differing patient populations, the risk of anastomotic failure was equivalent when comparing HS and ST anastomoses. Level of Evidence: Therapeutic study, level II.

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