Implementation of Colectomy Guidelines: Increasing Rate of Safe Anastomosis in Emergency General Surgery Patients

INTRODUCTION: Creation of a colostomy versus anastomosis remains a controversial topic in emergency general surgery (EGS) patients requiring emergent or urgent colon resection. In 2017, our institution standardized the indications for colostomy creation in EGS patients, which included the presence of septic shock, poor tissue condition at the anastomotic site, and conditions associated with poor wound healing. In the absence of these conditions, the guideline recommended anastomosis. The goal of this study is to examine rates of colostomy, anastomosis, and abdominal complications before (PRE) and after (POST) guideline implementation. METHODS: This is a single-institution, retrospective review of EGS patients over a 10-y period who underwent urgent or emergent colon resection by the EGS service. Demographics, comorbidities, operations, preoperative and postoperative courses were recorded and analyzed before and after implementation of colectomy management guidelines. RESULTS: Between January 1, 2013 and October 31, 2022, 710 patients underwent segmental colon resection (283 PRE/427 POST). The PRE and POST groups were similar with respect to sex (F 48.1% versus 51.8%, P = 0.43), Charlson Comorbidity Index (3.7 interquartile range [IQR] 5.6 PRE versus 3.8 IQR 5.6 POST, P = 0.50), and American Society of Anesthesiologists score (3.5 IQR 1.0 PRE versus 3.0 IQR 1.0 POST, P = 0.08). Anastomosis was significantly more common in the POST group compared to PRE (32.9% versus 43.1%, P = 0.008). Intestinal leak, abscess, and wound dehiscence rates were similar in PRE and POST groups (P > 0.05) despite fewer colostomies. CONCLUSIONS: Implementation of an EGS colon management guideline was associated with a significantly higher rate of anastomosis creation but no concomitant increase in leak or abdominal complications.