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Evolution of the Treatment of the Injured Colon in the 1980s
Jon M. Burch, MD;
R. Russell Martin, MD;
Robert J. Richardson, MD;
David S. Muldowny, MD;
Kenneth L. Mattox, MD;
George L. Jordan, Jr, MD
Arch Surg. 1991;126(8):979-984.
Abstract
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• During the past 10 years, 1006 patients with colon injuries were treated in an urban trauma center. Primary repair, including suture repair and resection with anastomosis, was performed in 614 patients (61%), colostomy in 284 patients (28%), and exteriorized repairs in 83 patients (8.3%). In the remaining 25 patients (2.5%) who were exsanguinating, the colon injuries were ligated. Independent risk factors for adverse outcomes (defined as a fecal fistula, abdominal abscess, stomal complication, or death from multisystem failure) were identified using multiple logistic regression analysis. These factors were used to match patients at similar risk within different treatment groups, and odds ratios for each treatment were calculated. The odds ratios for primary repair, colostomy, and exteriorized repair were 1.0,1.9, and 2.0, respectively. Therefore, the chance of an adverse outcome was twice as great for both exteriorized repair or colostomy as for primary repair. It is concluded that further increases in the use of primary repair are warranted.
(Arch Surg. 1991;126:979-984)
Author Affiliations
From the Cora and Webb Mading Department of Surgery, Baylor College of Medicine, and the Ben Taub General Hospital, Houston, Tex. Dr Muldowny is now with the Department of Orthopedic Surgery, Tulane University, New Orleans, La.
Footnotes
Accepted for publication April 28, 1991.
Read before the 98th Annual Meeting of the Western Surgical Association, Scottsdale, Ariz, November 12, 1990.
Reprint requests to Department of Surgery, Baylor College of Medicine, Houston, TX 77030 (Dr Burch).
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