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World Journal of Surgery

, Volume 43, Issue 1, pp 169–174 | Cite as

Ostomy Usage for Colorectal Trauma in Combat Casualties

  • Luke R. JohnstonEmail author
  • Matthew J. Bradley
  • Carlos J. Rodriguez
  • Michael P. Mcnally
  • Eric A. Elster
  • James E. Duncan
Original Scientific Report
  • 68 Downloads

Abstract

Introduction

The role for diverting ostomy as a method to help reduce morbidity and mortality has been well established in the combat trauma population. However, factors that influence the type of ostomy used and which ostomies become permanent are poorly studied. We examine patterns of ostomy usage and reversal in a large series of combat trauma patients.

Methods

We performed a retrospective review of combat casualties treated at our continental U.S. military treatment facility from 2003 to 2015. All patients who underwent ostomy formation were included. Clinical and demographic factors were collected for all patients including the type of ostomy and whether or not ostomy reversal took place. Patients were grouped and analyzed based on ostomy type and by ostomy reversal.

Results

We identified 202 patients who had ostomies created. End colostomies were most common (N = 149) followed by loop colostomies (N = 34) and end ileostomies (N = 19). Casualties that underwent damage control laparotomy (DCL) were less likely to have a loop colostomy created (p < 0.001). Ostomy reversal occurred in 89.9% of patients. There was no difference in ostomy reversal rates by ostomy type (p = 0.080). Presence of a pelvic fracture was associated with permanent ostomy (OR = 3.28, p = 0.019), but no factor independently predicted a permanent ostomy on multivariate analysis.

Discussion

DCL and a severe perineal injury most strongly influence ostomy type selection. Most patients undergo colostomy reversal, and no factor independently predicted an ostomy being permanent. These findings provide a framework for understanding the issue of fecal diversion in the combat trauma population and inform military surgeons about injury patterns and treatment options.

Notes

Acknowledgements

The opinions or assertions contained herein are the private ones of the author/speaker and are not to be construed as official or reflecting the views of the Department of Defense, the Uniformed Services University of the Health Sciences or any other agency of the U.S. Government. The views expressed in this presentation are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government. The study protocol was approved by the Walter Reed Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection 2018

Authors and Affiliations

  • Luke R. Johnston
    • 1
    Email author
  • Matthew J. Bradley
    • 1
    • 2
    • 3
  • Carlos J. Rodriguez
    • 1
  • Michael P. Mcnally
    • 1
  • Eric A. Elster
    • 1
    • 3
  • James E. Duncan
    • 1
  1. 1.Department of SurgeryUniformed Services University of the Health Sciences-Walter Reed National Military Medical CenterBethesdaUSA
  2. 2.Department of Regenerative MedicineNaval Medical Research CenterSilver SpringUSA
  3. 3.Surgical Critical Care InitiativeBethesdaUSA

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