Rates and risk factors for anastomotic leak following blunt trauma-associated bucket handle intestinal injuries: a multicenter study

Holly Grossman; Chathurka Samudani Dhanasekara; Kripa Shrestha; Brianna Marschke; Erin Morris; Robyn Richmond; Ara Ko; Lakshika Tennakoon; Eric M Campion; Frank C Wood; Maggie Brandt; Grace Ng; Justin L Regner; Stacey L Keith; Michelle K McNutt; Heather Kregel; Rajesh R Gandhi; Thomas J Schroeppel; Daniel R Margulies; Yassar M Hashim; Joseph Herrold; Mallory Goetz; LeRone Simpson; Xuan-Lan Doan; Sharmila Dissanaike

doi:10.1136/tsaco-2023-001178

Rates and risk factors for anastomotic leak following blunt trauma-associated bucket handle intestinal injuries: a multicenter study

Trauma Surg Acute Care Open. 2023 Nov 22;8(1):e001178. doi: 10.1136/tsaco-2023-001178. eCollection 2023.

Authors

Holly Grossman¹, Chathurka Samudani Dhanasekara¹, Kripa Shrestha¹, Brianna Marschke¹, Erin Morris¹, Robyn Richmond¹, Ara Ko², Lakshika Tennakoon², Eric M Campion³, Frank C Wood⁴, Maggie Brandt⁴, Grace Ng⁵, Justin L Regner⁶, Stacey L Keith⁶, Michelle K McNutt⁷, Heather Kregel⁷, Rajesh R Gandhi⁸, Thomas J Schroeppel⁹, Daniel R Margulies¹⁰, Yassar M Hashim¹⁰, Joseph Herrold¹¹, Mallory Goetz¹¹, LeRone Simpson¹², Xuan-Lan Doan¹², Sharmila Dissanaike¹

Affiliations

¹ Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
² Department of Surgery, Stanford Medicine, Stanford, California, USA.
³ Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA.
⁴ Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
⁵ Department of Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA.
⁶ Department of Surgery, Baylor Scott & White Medical Center Temple, Temple, Texas, USA.
⁷ Department of Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA.
⁸ Department of Surgery, JPS Health Network, Fort Worth, Texas, USA.
⁹ Department of Surgery, University of Colorado Health, Aurora, Colorado, USA.
¹⁰ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
¹¹ Department of Surgery, University of Maryland, Baltimore, Maryland, USA.
¹² Department of Surgery, McAllen Medical Center, McAllen, Texas, USA.

Abstract

Objectives: The risk factors for anastomotic leak (AL) after resection and primary anastomosis for traumatic bucket handle injury (BHI) have not been previously defined. This multicenter study was conducted to address this knowledge gap.

Methods: This is a multicenter retrospective study on small intestine and colonic BHIs from blunt trauma between 2010 and 2021. Baseline patient characteristics, risk factors, presence of shock and transfusion, operative details, and clinical outcomes were compared using R.

Results: Data on 395 subjects were submitted by 12 trauma centers, of whom 33 (8.1%) patients developed AL. Baseline details were similar, except for a higher proportion of patients in the AL group who had medical comorbidities such as diabetes, hypertension, and obesity (60.6% vs. 37.3%, p=0.015). AL had higher rates of surgical site infections (13.4% vs. 5.3%, p=0.004) and organ space infections (65.2% vs. 11.7%, p<0.001), along with higher readmission and reoperation rates (48.4% vs. 9.1%, p<0.001, and 39.4% vs. 11.6%, p<0.001, respectively). There was no difference in intensive care unit length of stay or mortality (p>0.05). More patients with AL were discharged with an ostomy (69.7% vs. 7.3%, p<0.001), and the mean duration until ostomy reversal was 5.85±3 months (range 2-12.4 months). The risk of AL significantly increased when the initial operation was a damage control procedure, after adjusting for age, sex, injury severity, presence of one or more comorbidities, shock, transfusion of >6 units of packed red blood cells, and site of injury (adjusted RR=2.32 (1.13, 5.17)), none of which were independent risk factors in themselves.

Conclusion: Damage control surgery performed as the initial operation appears to double the risk of AL after intestinal BHI, even after controlling for other markers of injury severity.

Level of evidence: III.

Keywords: Intestine, Small; Ischemia; abdominal injuries; colon.