RESHAPES: Increasing AAST EGS grade is associated with anastomosis type

Area of Science:

• Surgical outcomes research
• Trauma surgery
• Gastrointestinal surgery

Background:

• Bowel resection and anastomosis are common in emergency general surgery (EGS).
• Hand-sewn (HS) and stapled (ST) anastomosis techniques are used, with surgeons often preferring HS for sicker patients.
• The SHAPES analysis showed HS and ST equivalence, but surgeon preference for HS in critically ill patients warrants further investigation.

Purpose of the Study:

• To investigate the association between disease severity, using the American Association for the Surgery of Trauma Emergency General Surgery (AAST EGS) grading system, and the choice of anastomosis technique (HS vs. ST).
• To explore the relationship between AAST EGS grade and patient outcomes, including anastomosis complications and mortality.

Main Methods:

• Post hoc analysis of the SHAPES database, including operative reports from volunteering centers.
• Comparison of AAST EGS grades with outcomes such as length of stay, physiological data, anastomosis type, anastomosis failure, and mortality.
• Regression analysis to identify factors associated with mortality.

Main Results:

• A total of 391 patients were analyzed, with increasing AAST EGS grades (II-V) showing association with acidosis and hypothermia.
• Higher AAST EGS grades were associated with a greater likelihood of using hand-sewn (HS) anastomosis.
• Mortality was linked to anastomosis complications and vasopressor use, but not directly to AAST EGS grade or anastomotic technique.

Conclusions:

• This study is the first to apply standardized anatomic injury grades (AAST) in EGS patients undergoing bowel resection.
• Higher AAST severity scores correlate with key clinical outcomes in EGS requiring bowel resection and anastomosis.
• Future EGS studies should incorporate AAST grading for consistent comparison of injury severity across patient groups.