Citations 2
Effect of Antibiotic Duration in Emergency General Surgery Patients with Intra-Abdominal Infection Managed with Open vs Closed Abdomen
Diaz, Jose J, Zielinski, Martin D, Chipman, Amanda M, O’Meara, Lindsay, Schroeppel, Thomas, Cullinane, Daniel, Shoultz, Thomas, Barnes, Stephen L, May, Addison K, Maung, Adrian A, Diaz, José J. , Diaz, Jose J, Zielinski, Martin D, Chipman, Amanda M, O’Meara, Lindsay, Schroeppel, Thomas, Cullinane, Daniel, Shoultz, Thomas, Barnes, Stephen L, May, Addison K, Maung, Adrian A
Journal of the American College of Surgeons | April 5, 2022 | Volume: 234 | Issue: 4 | Pages: 419-427
BACKGROUND: Data on duration of antibiotics in patients managed with an open abdomen (OA) due to intra-abdominal infection (IAI) are scarce. We hypothesized that patients with IAI managed with OA rather than closed abdomen (CA) would have higher rates of secondary infections (SIs) independent of the duration of the antibiotic treatment. METHODS: This was an observational, prospective, multicenter, international study of patients with IAI requiring laparotomy for source control. Demographic and antibiotic duration values were collected. Primary outcomes were SI (surgical site, bloodstream, pneumonia, urinary tract) and mortality. Statistical analysis included ANOVA, chi-square/Fisher’s exact test, and logistic regression. RESULTS: Twenty-one centers contributed 752 patients. The average age was 59.6 years, 43.6% were women, and 43.9% were managed with OA. Overall mortality was 16.1%, with higher rates among OA patients (31.6% vs 4.4%, p < 0.001). OA patients had higher Sequential Organ Failure Assessment (4.7 vs 1.8, p < 0.001), American Society of Anesthesiologists Physical Status (3.6 vs 2.7, p < 0.001), and APACHE II scores (16.1 vs 9.4, p < 0.001). The mean duration of antibiotics was 6.5 days (8.0 OA vs 5.4 CA, p < 0.001). A total of 179 (23.8%) patients developed SI (33.1% OA vs 16.8% CA, p < 0.001). Longer antibiotic duration was associated with increased rates of SI: 1 to 2 days, 15.8%; 3 to 5 days, 20.4%; 6 to 14 days, 26.6%; and more than 14 days, 46.8% (p < 0.001). CONCLUSIONS: Patients with IAI managed with OA had higher rates of SI and increased mortality compared with CA. A prolonged duration of antibiotics was associated with increased rates of SI. Increased antibiotic duration is not associated with improved outcomes in patients with IAI and OA.
Validation of the American Association for the Surgery of Trauma Emergency General Surgery Grading System for Colorectal Resection: An EAST Multicenter Study
Aicher, Brittany O. , Betancourt, Alejandro Mohar , Grossman, Michael D., Heise, Holly, Zielinski, Martin D. , Kongkaewpaisan, Napaporn , Kaafarani, Haytham M.A. , Wagner, Afton, Grabo, Daniel, Peck, Gregory , Chang, Gloria, Cullinane, Laura M., Stocker, Benjamin , Simonoski, Ursula J., Catalano, Richard D., Vasileiou, Georgia , Agrawal, Vaidehi , Truitt, Michael S., Pickett, Maryanne L. , Dultz, Linda A. , Müller, Alison, Ong, Adrian W. , Roman, Janika L. San, Barth, Nadine, Fackelmayer, Oliver J. , Velopulos, Catherine G. , Hendrix, Cheralyn J. , Estroff, Jordan M. , Gambhir, Sahil , Jeyamurugan, Kokila , Bugaev, Nikolay , O’Meara, Lindsay , Kufera, Joseph A., Diaz, José J. , Bruns, Brandon , Schroeppel, Thomas J. , Hernandez, Matthew C. , Scott, Michael, Matsushima, Kazuhide , Cullinane, Daniel C. , Posluszny, Joseph A. , Yeh, D. Dante , Nahmias, Jeffry T.
The American Surgeon™ | March 11, 2022 | Volume: 88 | Issue: 5 | Pages: 953-958
Background The American Association for the Surgery of Trauma (AAST) has developed a grading system for emergency general surgery (EGS) conditions. We sought to validate the AAST EGS grades for patients undergoing urgent/emergent colorectal resection. Methods Patients enrolled in the “Eastern Association for the Surgery of Trauma Multicenter Colorectal Resection in EGS—to anastomose or not to anastomose” study undergoing urgent/emergent surgery for obstruction, ischemia, or diverticulitis were included. Baseline demographics, comorbidity severity as defined by Charlson comorbidity index (CCI), procedure type, and AAST grade were prospectively collected. Outcomes included length of stay (LOS) in-hospital mortality, and surgical complications (superficial/deep/organ-space surgical site infection, anastomotic leak, stoma complication, fascial dehiscence, and need for further intervention). Multivariable logistic regression models were used to describe outcomes and risk factors for surgical complication or mortality. Results There were 367 patients, with a mean (± SD) age of 62 ± 15 years. 39% were women. The median interquartile range (IQR) CCI was 4 (2-6). Overall, the pathologies encompassed the following AAST EGS grades: I (17, 5%), II (54, 15%), III (115, 31%), IV (95, 26%), and V (86, 23%). Management included laparoscopic (24, 7%), open (319, 87%), and laparoscopy converted to laparotomy (24, 6%). Higher AAST grade was associated with laparotomy ( P = .01). The median LOS was 13 days (8-22). At least 1 surgical complication occurred in 33% of patients and the mortality rate was 14%. Development of at least 1 surgical complication, need for unplanned intervention, mortality, and increased LOS were associated with increasing AAST severity grade. On multivariable analysis, factors predictive of in-hospital mortality included AAST organ grade, CCI, and preoperative vasopressor use (odds ratio (OR) 1.9, 1.6, 3.1, respectively). The American Association for the Surgery of Trauma emergency general surgery grade was also associated with the development of at least 1 surgical complication (OR 2.5), while CCI, preoperative vasopressor use, respiratory failure, and pneumoperitoneum were not. Conclusion The American Association for the Surgery of Trauma emergency general surgery grading systems display construct validity for mortality and surgical complications after urgent/emergent colorectal resection. These results support incorporation of AAST EGS grades for quality benchmarking and surgical outcomes research.