To close or not to close? Wound management in emergent colorectal surgery, an EAST Multicenter prospective cohort study.

BACKGROUND: To determine the clinical impact of wound management technique on surgical site infection (SSI), hospital length of stay (LOS) and mortality in emergent colorectal surgery. METHODS: A prospective observational study (2021-2023) of urgent or emergent colorectal surgery patients at 15 institutions was conducted. Pediatric patients and traumatic colorectal injuries were excluded. Patients were classified by wound closure technique: skin closed (SC), skin loosely closed (SLC), or skin open (SO). Primary outcomes were SSI, hospital LOS and in-hospital mortality rates. Multivariable regression was used to assess the effect of wound closure on outcomes after controlling for demographics, patient characteristics, ICU admission, vasopressor use, procedure details and wound class. A priori power analysis indicated that 138 patients per group were required to detect a 10% difference in mortality rates. RESULTS: In total, 557 patients were included (SC n = 262, SLC n = 124, SO n = 171). Statistically significant differences in BMI, race/ethnicity, ASA scores, EBL, ICU admission, vasopressor therapy, procedure details, and wound class were observed across groups (Table 1). Overall, average LOS was 16.9 ± 16.4 days, and rates of in-hospital mortality and SSI were 7.9% and 18.5%, respectively, with the lowest rates observed in the SC group (Table 2). After risk adjustment, SO was associated with increased risk of mortality (OR = 3.003, p = 0.028 in comparison to the SC group. SLC was associated with increased risk of superficial SSI (OR = 3.439, p = 0.014), after risk adjustment. CONCLUSION: When compared to the SC group, the SO group was associated with mortality, but comparable when considering all other outcomes, while the SLC was associated with increased superficial SSI. Complete skin closure may be a viable wound management technique in emergent colorectal surgery. STUDY TYPE: Level III Therapeutic/Care Management.

Mean arterial pressure (MAP) augmentation in traumatic spinal cord injuries: Early hyperperfusion treatment influences neurologic outcomes.

CONTEXT: Hyperperfusion therapy, mean arterial blood pressure (MAP) > 85 mmHg, is a recommended treatment of blunt traumatic spinal cord injury (SCI). We hypothesized the first 24 h of MAP augmentation would be most influential on neurological outcomes. DESIGN: This retrospective study from a level 1 urban trauma center dating 1/2017 to 12/2019 included all blunt traumatic spinal cord injured patients receiving hyperperfusion therapy. Patients were grouped as "No improvement" vs "Improvement" measured by change in American Spinal Injury Association (ASIA) score during their hospitalization. MAP values for the first 12, first 24 and last 72 h were compared between the two groups; P < 0.05 was significant. RESULTS: After exclusions, 96 patients underwent hyperperfusion therapy for blunt traumatic SCI, 82 in the No Improvement and 14 in the Improvement group. Groups had similar treatment durations (95.6 and 96.7 h, P = 0.66) and ISS (20.5 and 23, P = 0.45). The area under the curve, calculation, to account for time less than goal and MAP difference from goal, in the No Improvement group was significantly higher (lower and more time below MAP goal) compared to the Improvement group for the first 12 h (40.3 v. 26.1 P = 0.03) with similar findings in the subsequent 12 h of treatment (13-24 h; 62.2 vs 43, P = 0.09). There was no difference between the groups in the subsequent 72 h (25-96 h; 156.4 vs 136.6, P = 0.57). CONCLUSIONS: Hyperperfusion to the spinal cord in the first 12 h correlated significantly with improved neurological outcome in SCI patients.