Journal article
Validation of the American Association for the Surgery of Trauma Emergency General Surgery Grading System for Colorectal Resection: An EAST Multicenter Study
The American surgeon, v 88(5), pp 953-958
May 2022
PMID: 35275764
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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.
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.
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 (
= .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.
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.
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Details
- Title
- Validation of the American Association for the Surgery of Trauma Emergency General Surgery Grading System for Colorectal Resection: An EAST Multicenter Study
- Creators
- Brittany O Aicher - University of Maryland Medical CenterAlejandro Betancourt-Ramirez - Northwell HealthMichael D Grossman - Northwell HealthHolly Heise - Memorial HospitalThomas J Schroeppel - Memorial HospitalMatthew C Hernandez - Mayo ClinicMartin D Zielinski - Mayo ClinicNapaporn Kongkaewpaisan - Massachusetts General HospitalHaytham M A Kaafarani - Massachusetts General HospitalAfton Wagner - West Virginia UniversityDaniel Grabo - West Virginia UniversityMichael Scott - Robert Wood Johnson University HospitalGregory Peck - Robert Wood Johnson University HospitalGloria Chang - University of Southern CaliforniaKazuhide Matsushima - University of Southern CaliforniaDaniel C Cullinane - Marshfield ClinicLaura M Cullinane - Marshfield ClinicBenjamin Stocker - Northwestern Memorial HospitalJoseph Posluszny - Northwestern Memorial HospitalUrsula J Simonoski - Loma Linda UniversityRichard D Catalano - Loma Linda UniversityGeorgia Vasileiou - Jackson Memorial HospitalDaniel Dante Yeh - Jackson Memorial HospitalVaidehi Agrawal - Methodist Dallas Medical CenterMichael S Truitt - Methodist Dallas Medical CenterMaryAnne Pickett - The University of Texas Southwestern Medical CenterLinda Dultz - The University of Texas Southwestern Medical CenterAlison Muller - Reading HospitalAdrian W Ong - Reading HospitalJanika L San Roman - Cooper University Health CareNadine Barth - Cooper University Health CareOliver Fackelmayer - University of Colorado DenverCatherine G Velopulos - University of Colorado DenverCheralyn Hendrix - George Washington UniversityJordan M Estroff - George Washington UniversitySahil Gambhir - University of California, IrvineJeffry Nahmias - University of California, IrvineKokila Jeyamurugan - Tufts UniversityNikolay Bugaev - Tufts UniversityLindsay O'Meara - University of Maryland Medical CenterJoseph Kufera - University of Maryland, BaltimoreJose J Diaz - University of Maryland, BaltimoreBrandon R Bruns - University of Maryland, Baltimore
- Publication Details
- The American surgeon, v 88(5), pp 953-958
- Publisher
- Sage
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000769590200001
- Scopus ID
- 2-s2.0-85126345366
- Other Identifier
- 991022020736204721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Surgery