Colorectal Anastomosis Versus Colostomy Creation in High MELD Patients: An ACS-NSQIP Analysis
Background Liver failure patients are at increased risk of surgical complications. The decision to perform a colonic anastomosis vs a colostomy in urgent colorectal surgery remains unclear. Methods The ACS-NSQIP database was queried for patients undergoing nonelective colorectal surgery between 2016...
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| Veröffentlicht in: | The American surgeon 2024-11, Vol.90 (11), p.2717-2723 |
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| container_title | The American surgeon |
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| creator | Karim, S. Ahsan Turcotte, Justin J. Rehrig, Scott T. Feather, Cristina B. Klune, J. Robert |
| description | Background
Liver failure patients are at increased risk of surgical complications. The decision to perform a colonic anastomosis vs a colostomy in urgent colorectal surgery remains unclear.
Methods
The ACS-NSQIP database was queried for patients undergoing nonelective colorectal surgery between 2016 and 2018. MELD score was calculated and stratified into 3 groups. Subgroup analysis of the high-MELD group was performed.
Results
Higher MELD scores were associated with significantly higher mortality. Colostomy formation was consistent between intermediate and high-MELD groups. In high-MELD patients, colonic anastomosis was associated with higher mortality than those receiving colostomy (41.1% vs 28.4%, P < .001). Patients receiving colostomy had higher rates of wound complications, but lower rates of return to OR and non-wound complications. Regression analysis revealed that colostomy formation remained an independent predictor of survival (mortality OR = .594, P < .001).
Discussion
High-MELD patients undergoing nonelective colorectal surgery have increased risk of complications such as mortality. Patients in this group receiving an anastomosis have increased complications and mortality, and may benefit from colostomy formation. |
| doi_str_mv | 10.1177/00031348241248787 |
| format | Article |
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Liver failure patients are at increased risk of surgical complications. The decision to perform a colonic anastomosis vs a colostomy in urgent colorectal surgery remains unclear.
Methods
The ACS-NSQIP database was queried for patients undergoing nonelective colorectal surgery between 2016 and 2018. MELD score was calculated and stratified into 3 groups. Subgroup analysis of the high-MELD group was performed.
Results
Higher MELD scores were associated with significantly higher mortality. Colostomy formation was consistent between intermediate and high-MELD groups. In high-MELD patients, colonic anastomosis was associated with higher mortality than those receiving colostomy (41.1% vs 28.4%, P < .001). Patients receiving colostomy had higher rates of wound complications, but lower rates of return to OR and non-wound complications. Regression analysis revealed that colostomy formation remained an independent predictor of survival (mortality OR = .594, P < .001).
Discussion
High-MELD patients undergoing nonelective colorectal surgery have increased risk of complications such as mortality. Patients in this group receiving an anastomosis have increased complications and mortality, and may benefit from colostomy formation.</description><identifier>ISSN: 0003-1348</identifier><identifier>ISSN: 1555-9823</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/00031348241248787</identifier><identifier>PMID: 38655821</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Aged ; Anastomosis ; Anastomosis, Surgical - methods ; Ascites ; Chronic obstructive pulmonary disease ; Colon ; Colon - surgery ; Colorectal surgery ; Colostomy - methods ; Comorbidity ; Demographics ; End Stage Liver Disease - mortality ; End Stage Liver Disease - surgery ; Female ; Hemodialysis ; Hospitals ; Humans ; Hypertension ; Kidney diseases ; Liver diseases ; Male ; Medical personnel ; Middle Aged ; Mortality ; Nursing homes ; Ostomy ; Postoperative Complications - epidemiology ; Rectum - surgery ; Regression analysis ; Retrospective Studies ; Sepsis ; Subgroups ; Surgeons ; Surgery ; Surgical outcomes ; Ventilators ; Wounds</subject><ispartof>The American surgeon, 2024-11, Vol.90 (11), p.2717-2723</ispartof><rights>The Author(s) 2024</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c320t-ec1e94912c977ef5bbd420dd084b0f147baafd3619c06bb49dee2cb6689fffa43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/00031348241248787$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/00031348241248787$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,777,781,21800,27905,27906,43602,43603</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38655821$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Karim, S. Ahsan</creatorcontrib><creatorcontrib>Turcotte, Justin J.</creatorcontrib><creatorcontrib>Rehrig, Scott T.</creatorcontrib><creatorcontrib>Feather, Cristina B.</creatorcontrib><creatorcontrib>Klune, J. Robert</creatorcontrib><title>Colorectal Anastomosis Versus Colostomy Creation in High MELD Patients: An ACS-NSQIP Analysis</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>Background
Liver failure patients are at increased risk of surgical complications. The decision to perform a colonic anastomosis vs a colostomy in urgent colorectal surgery remains unclear.
Methods
The ACS-NSQIP database was queried for patients undergoing nonelective colorectal surgery between 2016 and 2018. MELD score was calculated and stratified into 3 groups. Subgroup analysis of the high-MELD group was performed.
Results
Higher MELD scores were associated with significantly higher mortality. Colostomy formation was consistent between intermediate and high-MELD groups. In high-MELD patients, colonic anastomosis was associated with higher mortality than those receiving colostomy (41.1% vs 28.4%, P < .001). Patients receiving colostomy had higher rates of wound complications, but lower rates of return to OR and non-wound complications. Regression analysis revealed that colostomy formation remained an independent predictor of survival (mortality OR = .594, P < .001).
Discussion
High-MELD patients undergoing nonelective colorectal surgery have increased risk of complications such as mortality. Patients in this group receiving an anastomosis have increased complications and mortality, and may benefit from colostomy formation.</description><subject>Aged</subject><subject>Anastomosis</subject><subject>Anastomosis, Surgical - methods</subject><subject>Ascites</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Colon</subject><subject>Colon - surgery</subject><subject>Colorectal surgery</subject><subject>Colostomy - methods</subject><subject>Comorbidity</subject><subject>Demographics</subject><subject>End Stage Liver Disease - mortality</subject><subject>End Stage Liver Disease - surgery</subject><subject>Female</subject><subject>Hemodialysis</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Kidney diseases</subject><subject>Liver diseases</subject><subject>Male</subject><subject>Medical personnel</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nursing homes</subject><subject>Ostomy</subject><subject>Postoperative Complications - epidemiology</subject><subject>Rectum - surgery</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Sepsis</subject><subject>Subgroups</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Ventilators</subject><subject>Wounds</subject><issn>0003-1348</issn><issn>1555-9823</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kElPwzAQhS0EgrL8AC7IEhcuAY_txDa3KqxS2cRyQ5GTOCVVGoOdHPrvcSiLBOI0mpnvvbEfQrtADgGEOCKEMGBcUg6USyHFChpBHMeRkpStotGwjwZgA216PwstT2JYRxtMJnEsKYzQc2ob60zR6QaPW-07O7e-9vjJON97PGyH2QKnzuiuti2uW3xRT1_w1enkBN-GmWk7fxzEeJzeR9f3d5e3g1OzCDbbaK3SjTc7n3ULPZ6dPqQX0eTm_DIdT6KCUdJFpgCjuAJaKCFMFed5ySkpSyJ5TirgIte6KlkCqiBJnnNVGkOLPEmkqqpKc7aFDpa-r86-9cZ32bz2hWka3Rrb-4x9fFxyIQK6_wud2d6F9wYKKICSTNFAwZIqnPXemSp7dfVcu0UGJBuyz_5kHzR7n859Pjflt-Ir7AAcLgGvp-bn7P-O7-sFimY</recordid><startdate>20241101</startdate><enddate>20241101</enddate><creator>Karim, S. Ahsan</creator><creator>Turcotte, Justin J.</creator><creator>Rehrig, Scott T.</creator><creator>Feather, Cristina B.</creator><creator>Klune, J. Robert</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7T7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20241101</creationdate><title>Colorectal Anastomosis Versus Colostomy Creation in High MELD Patients: An ACS-NSQIP Analysis</title><author>Karim, S. Ahsan ; Turcotte, Justin J. ; Rehrig, Scott T. ; Feather, Cristina B. ; Klune, J. Robert</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c320t-ec1e94912c977ef5bbd420dd084b0f147baafd3619c06bb49dee2cb6689fffa43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Anastomosis</topic><topic>Anastomosis, Surgical - methods</topic><topic>Ascites</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Colon</topic><topic>Colon - surgery</topic><topic>Colorectal surgery</topic><topic>Colostomy - methods</topic><topic>Comorbidity</topic><topic>Demographics</topic><topic>End Stage Liver Disease - mortality</topic><topic>End Stage Liver Disease - surgery</topic><topic>Female</topic><topic>Hemodialysis</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Kidney diseases</topic><topic>Liver diseases</topic><topic>Male</topic><topic>Medical personnel</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Nursing homes</topic><topic>Ostomy</topic><topic>Postoperative Complications - epidemiology</topic><topic>Rectum - surgery</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Sepsis</topic><topic>Subgroups</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Ventilators</topic><topic>Wounds</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Karim, S. Ahsan</creatorcontrib><creatorcontrib>Turcotte, Justin J.</creatorcontrib><creatorcontrib>Rehrig, Scott T.</creatorcontrib><creatorcontrib>Feather, Cristina B.</creatorcontrib><creatorcontrib>Klune, J. Robert</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Karim, S. Ahsan</au><au>Turcotte, Justin J.</au><au>Rehrig, Scott T.</au><au>Feather, Cristina B.</au><au>Klune, J. Robert</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Colorectal Anastomosis Versus Colostomy Creation in High MELD Patients: An ACS-NSQIP Analysis</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2024-11-01</date><risdate>2024</risdate><volume>90</volume><issue>11</issue><spage>2717</spage><epage>2723</epage><pages>2717-2723</pages><issn>0003-1348</issn><issn>1555-9823</issn><eissn>1555-9823</eissn><abstract>Background
Liver failure patients are at increased risk of surgical complications. The decision to perform a colonic anastomosis vs a colostomy in urgent colorectal surgery remains unclear.
Methods
The ACS-NSQIP database was queried for patients undergoing nonelective colorectal surgery between 2016 and 2018. MELD score was calculated and stratified into 3 groups. Subgroup analysis of the high-MELD group was performed.
Results
Higher MELD scores were associated with significantly higher mortality. Colostomy formation was consistent between intermediate and high-MELD groups. In high-MELD patients, colonic anastomosis was associated with higher mortality than those receiving colostomy (41.1% vs 28.4%, P < .001). Patients receiving colostomy had higher rates of wound complications, but lower rates of return to OR and non-wound complications. Regression analysis revealed that colostomy formation remained an independent predictor of survival (mortality OR = .594, P < .001).
Discussion
High-MELD patients undergoing nonelective colorectal surgery have increased risk of complications such as mortality. Patients in this group receiving an anastomosis have increased complications and mortality, and may benefit from colostomy formation.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>38655821</pmid><doi>10.1177/00031348241248787</doi><tpages>7</tpages></addata></record> |
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| ispartof | The American surgeon, 2024-11, Vol.90 (11), p.2717-2723 |
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| subjects | Aged Anastomosis Anastomosis, Surgical - methods Ascites Chronic obstructive pulmonary disease Colon Colon - surgery Colorectal surgery Colostomy - methods Comorbidity Demographics End Stage Liver Disease - mortality End Stage Liver Disease - surgery Female Hemodialysis Hospitals Humans Hypertension Kidney diseases Liver diseases Male Medical personnel Middle Aged Mortality Nursing homes Ostomy Postoperative Complications - epidemiology Rectum - surgery Regression analysis Retrospective Studies Sepsis Subgroups Surgeons Surgery Surgical outcomes Ventilators Wounds |
| title | Colorectal Anastomosis Versus Colostomy Creation in High MELD Patients: An ACS-NSQIP Analysis |
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