Open and Endovascular Abdominal Aortic Injury Repair Outcomes in Polytrauma Patients.

INTRODUCTION: The management of patients with abdominal aortic injury (AAI) remains challenging. Open repair of AAI is still the standard of care although it is associated with high mortality. In past few years, endovascular surgery has evolved as a less invasive alternative to open surgery in emergency settings. The objective of this study was to compare outcomes after open repair versus endovascular repair of AAI in polytrauma patients. METHODS: The National Trauma Data Bank, from 2008 to 2012, was queried to identify trauma patients undergoing open and endovascular repair of AAI using International Classification of Diseases, ninth Edition, and Clinical Modification codes. Data reviewed included demographics, type of associated injury, type of operative management, and complications. Factors independently associated with mortality were evaluated using multivariate logistic regression model. RESULTS: Of 325 injured patients with AAI, 91 patients underwent endovascular repair and 234 patients underwent open repair. Of these, 80.6% were male, with a mean age of 35.70 years, and a mean injury severity score (ISS) was 30.59 for patients undergoing open repair and 31.56 for endovascular repair. Associated traumatic injuries included bowel injuries 57.5%, liver-pancreas injuries 36.6%, splenic injuries 14.8%, renal injuries 15.7%, and retroperitoneal injuries 19.1%. In-patient mortality for patients undergoing the open repair cohort was 63.7% and 20.9% for patients in the endovascular cohort (P < 0.001). The endovascular repair cohort patients had a higher incidence of pneumonia 17.6% as compared to open repair cohort 5.1% (P < 0.001). Similarly, patients in the endovascular repair cohort also had a higher abdominal compartment syndrome (4.4% vs. 0.4% in the open repair cohort, P = 0.009), postoperative acute kidney injury (9.9% endovascular repair cohort vs. 6.4% in the open repair cohort, P = 0.281), and acute mesenteric ischemia (1.1%). After controlling for associated injuries, acidosis, blood pressure at presentation, age, and ISS, patients in the open repair cohort had 6.58 times higher odds (confidence interval: 3.25-13.33; P < 0.001) of mortality as compared to the endovascular repair cohort. CONCLUSIONS: Endovascular repair of abdominal aorta in polytrauma patients seems to be feasible and may improve survivorship in appropriately selected patients. More research is needed to understand to identify indications for endovascular repair versus open repair.

Comparison of surgical incision complete closure versus leaving skin open in wound class IV in emergent colon surgery.

INTRODUCTION: Our aim was to compare the effect of techniques of wound closure in the emergent colon surgery with wound class IV. METHODS: Using 2014 the colectomy targeted ACS-NSQIP dataset; we identified patients undergoing emergent colectomy with wound class IV. Comparison of surgical incision complete closure versus leaving the skin open and multivariate logistic regression analyses was performed. RESULTS: Of 1792 patients undergoing emergent colectomy with wound class IV, the complete closure cohort had 1376 patients and the incision skin open cohort had 416 patients. The incidence of deep SSI was 2.3% in the complete closure cohort vs. 1.2% in the incision skin open, p = 0.15, and intra-abdominal abscess rate was 11.8% in the complete closure cohort vs. 12.3% in the incision skin open, p = 0.78. The dehiscence rate, readmission rate, and reoperation rates were not statistically significant between two cohorts. A multivariate model for dehiscence did not yield significant association between the complete closure cohort and incision skin open cohort. CONCLUSIONS: Surgical incision complete wound closure in the emergent colon surgery with wound class III/IV is safe and effective.