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Citation
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Dilday MJ, Owattanapanich N, Benjamin ER, Biswas S, Shackelford CS, Demetriades D. J. Trauma Acute Care Surg. 2023; ePub(ePub): ePub. |
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Abstract
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INTRODUCTION: Colon and rectal injuries have been diverted at higher rates in military trauma compared to civilian injuries. However, in the last few years there has been a shift to more liberal primary anastomosis in wartime injuries. The purpose of this study was to compare the management and outcomes in colorectal gunshot wounds (GSW) between military and civilian settings.
METHODS: The study included Department of Defense Trauma Registry (DoDTR) and TQIP database patients who sustained colorectal GSWs, during the period 2013-2016. DoDTR patients were propensity score matched 1:3 based on age, gender, grade of colorectal injury and extraabdominal AIS. Patients without signs of life, transfers from an outside hospital, and nonspecific colorectal organ injury scale (OIS) were excluded. Operative management and outcomes were compared between the two groups. Subanalysis was performed on the military cohort to identify any differences in the use primary repair, colectomy, or fecal diversion based upon military affiliation or NATO status.
RESULTS: Overall, there were 2,693 patients with colorectal GSWs; 60 patients in the military (MIL) group were propensity score matched with 180 patients in the civilian (CIV) group. Overall, colectomy was the most common procedure performed (72.1%) and was used more frequently in the MIL group (83.3% vs. 68.3%; p < 0.05). However, the rate of fecal diversion was similar in the two groups (23.3% vs. 27.8%; p = 0.500). Among those in the MIL group, no difference was seen in primary repair, colectomy, or fecal diversion based upon military affiliation or NATO status.The rates of in-hospital compilations and mortality were similar between the MIL and CIV groups.
CONCLUSIONS: The severity of GSW colorectal injuries in military and civilian trauma were comparable. There was no significant difference in terms of fecal diversion, mortality and complications between groups. Military personnel are treated similarly regardless of affiliation. LEVEL OF EVIDENCE: Therapeutic /care management, level III.
Language: en |