Stapled versus handsewn: A prospective emergency surgery study (SHAPES). An American Association for the Surgery of Trauma multi-institutional study.

Background: Data from the trauma patient population suggests handsewn anastomoses (HS) are superior to stapled (ST). A recent retrospective study in emergency general surgery (EGS) patients had similar findings. The aim of the current study is to evaluate HS and ST anastomoses in EGS patients undergoing urgent/emergent operations. Methods: The study was sponsored by the AAST Multi-Institutional Studies Committee. Patients undergoing urgent/emergent bowel resection for EGS pathology were prospectively enrolled from 7/22/2013-12/31/2015. 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 & 396 ST). Mean age was 61-years, 51% were male, 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 ICU 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 (OR 1.965; 95% CI 1.183-3.264) and the patient being managed with open abdomen (OR 2.529; 95% CI 1.492-4.286) were independently associated with anastomotic failure, while the type of anastomosis was not. Conclusions: 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: II STUDY TYPE: Therapeutic (C) 2016 Lippincott Williams & Wilkins, Inc.

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