Journal article
Morbidity and mortality in patients undergoing fecal diversion as an adjunct to wound healing: a NSQIP comparison study
European journal of plastic surgery, v 42(3), pp 283-290
01 Jun 2019
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BackgroundFecal diversion for chronic, non-healing wounds improves quality of life, assists in wound healing, and helps to prepare for reconstructive surgery. While commonplace, little has been published regarding the safety of diversion in this patient subgroup. The purpose of this study is to elucidate the morbidity and mortality of fecal diversion for chronic wounds and to identify those patients with disproportionately high perioperative risk.MethodsRetrospective analyses were performed using the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database and an institutional database. The primary outcome analyzed was 30-day mortality and secondary outcomes included 30-day morbidity and readmission rate.ResultsEight hundred fifty-nine patients were identified in the NSQIP database who underwent diversion compared to 3990 who did not. In unmatched data, there were no significant differences in substantial 30-day morbidities. In matched data, diverted patients had a significantly lower perioperative mortality. Fifty-six patients were identified in the institutional review who were diverted for non-healing wounds. Fifty percent of patients with a preoperative ejection fraction of less than 30% died within 30days of surgery (LR 6.58, p=0.045).ConclusionsThe NSQIP review indicates that fecal diversion does not inherently increase 30-day perioperative morbidity or mortality. While 30-day morbidity remains high, the institutional review suggests that patients with cardiac dysfunction contribute to the majority of complications. As such, an ejection fraction less than 30% may be a relative contraindication to immediate diversion. Medical optimization and elective diversion should be considered whenever feasible.Level of Evidence: Level III, risk / prognostic study.
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Details
- Title
- Morbidity and mortality in patients undergoing fecal diversion as an adjunct to wound healing: a NSQIP comparison study
- Creators
- Matthew E. Pontell - Drexel UniversityRobert Kucejko - Drexel UniversityDane Scantling - Drexel UniversityMichael Weingarten - Drexel UniversityDavid Stein - Drexel University
- Publication Details
- European journal of plastic surgery, v 42(3), pp 283-290
- Publisher
- Springer Nature
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- MD (Doctor of Medicine) Program; Surgery
- Web of Science ID
- WOS:000468846300011
- Scopus ID
- 2-s2.0-85066140393
- Other Identifier
- 991019168358504721
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- Web of Science research areas
- Surgery