RESHAPES: Increasing AAST EGS Grade is associated with anastomosis type

AbstractIntroductionThreatened, 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 AAST EGS grading system.MethodsWe 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.Results391 patients were reviewed, with a mean of age (±SD) 61.2±16.8 years, 47% female. 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 utilization but not increasing AAST EGS grade or anastomotic technique.ConclusionThis is the first study to utilize 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.Study TypePost hoc multi-institutional prospectiveLevel of EvidenceIII 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 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 391 patients were reviewed, with a mean of age (±SD) 61.2±16.8 years, 47% female. 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 utilization but not increasing AAST EGS grade or anastomotic technique. Conclusion This is the first study to utilize 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. Study Type Post hoc multi-institutional prospective Level of Evidence III Corresponding Author: Matthew C Hernandez MD, Division of Trauma Critical Care General Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, Email: hernandez.matthew@mayo.edu Presentation: 76th Annual Meeting of the AAST, September 13-16, 2017, Baltimore, Maryland The authors have no financial conflicts to disclose. © 2018 Lippincott Williams & Wilkins, Inc.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2IqIG2w