Proximal protective diverting ostomy following colon anastomosis for penetrating trauma may not be protective: A matched cohort study

Abstract

IntroductionDespite the shift toward liberal primary anastomosis in penetrating colon injuries, some surgeons recommend a protective diverting ostomy (DO) proximal to the anastomosis. This study evaluates the effect of DO on outcomes in patients undergoing colon resection and anastomosis following penetrating trauma. MethodsThe TQIP database (2013–2018) was queried for penetrating colon injuries undergoing colectomy and anastomosis. Patients receiving DO were propensity matched to patients without diverting ostomy (woDO) (1:3). Outcomes were compared between groups. ResultsAfter matching, 89 DO patients were analyzed. The DO group had more surgical site infections (32 ​% vs. 21 ​%; p ​< ​0.05) and longer hospital stay (20 [13–27] vs. 15 [9–25]; p ​< ​0.05) compared to the woDO group. Mortality and unplanned operations were similar between groups. ConclusionsDiverting ostomy after colon resection and anastomosis is associated with increased infectious complications without decreasing unplanned operations or mortality. Its routine role in penetrating colon trauma needs reassessment.