Key result
Stapled bowel anastomoses in emergency general surgery were associated with a higher risk of anastomotic failure than hand-sewn anastomoses (15.0% vs 6.1%; OR 2.65, 95% CI 1.08-6.50).
Why the study?
Does stapled anastomosis compared to hand-sewn anastomosis increase anastomotic failure in emergency general surgery patients?
Cohort (n=231)
No
Does stapled anastomosis compared to hand-sewn anastomosis increase anastomotic failure in emergency general surgery patients?
Odds Ratio: 2.65 (95% CI 1.08–6.5)
Absolute Event Rate: 15% vs 6.1%
p-value: p=0.034
In emergency general surgery patients undergoing bowel resection, stapled anastomoses are associated with more than twice the risk of anastomotic failure compared to hand-sewn anastomoses.
Should not yet change anastomosis technique; leaves open need for randomized trials to confirm higher stapled failure risk.
BACKGROUND: Recent studies have identified unique clinical and physiologic characteristics of emergency general surgery (EGS) patients and called for outcomes data in this population. There are no data in the US literature analyzing the impact of technique on anastomotic failure rates in EGS patients. The purpose of the current study was to compare outcomes of hand-sewn (HS) versus stapled (ST) bowel anastomoses in EGS patients. METHODS: A retrospective chart review of all patients admitted by our EGS service undergoing bowel resection for emergent indications from January 2007 to July 2011 was performed. Time from surgery to diagnosis of anastomotic failure was recorded as were the diagnostic modality and treatment of each anastomotic failure. Specific data on damage-control techniques, if used, were also collected. RESULTS: There were 100 HS (43%), and 133 ST (57%) anastomoses in 231 patients. Operative times were shorter in ST anastomosis technique (205 minutes for HS vs. 193 minutes for ST, p = 0.02). Anastomotic failures were identified in 26 patients (11%) and were significantly higher in the ST group than the HS group (15.0% vs. 6.1%, p = 0.003). A multivariate logistic regression analysis, controlling for age and preoperative nutritional status, revealed ST technique to be an independent risk factor for anastomotic failure (odds ratio, 2.65; 95% confidence interval, 1.08-6.50; p = 0.034). CONCLUSION: Anastomotic failures are more than twice as likely with ST than HS anastomoses in the EGS population. This is true even when controlling for markers of preoperative nutrition and demographics. These data suggest that the HS anastomosis should be the preferred method of reconstruction after bowel resection in EGS patients.
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Farrah et al. (2013) conducted a cohort in Emergency general surgery requiring bowel resection (n=231). Stapled bowel anastomoses vs. Hand-sewn bowel anastomoses was evaluated on Anastomotic failure (OR 2.65, 95% CI 1.08-6.50, p=0.034). Stapled bowel anastomoses in emergency general surgery were associated with a higher risk of anastomotic failure than hand-sewn anastomoses (15.0% vs 6.1%; OR 2.65, 95% CI 1.08-6.50).
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