Selective Preoperative Imaging Before Ostomy Reversal in Trauma Patients

Preoperative imaging before ostomy reversal in trauma patients is understudied. We hypothesized that imaging would infrequently identify clinically actionable findings and that routine imaging would represent a less cost-effective strategy.

Trauma patients with ostomy creation at a Level 1 trauma center (2017-2024) were identified. Associations between injury patterns, imaging, intraoperative factors, and surgical outcomes were analyzed using univariable and multivariable methods. A decision analytic model was developed to evaluate the cost-effectiveness of routine imaging before ostomy reversal.

Of 280 patients with intestinal injuries, 70 required ostomies, and 55 underwent reversal. Preoperative imaging was performed in 36 (65%) patients, identifying rectal narrowing in two (3.6%). Loop ostomy (odds ratio 5.7, P = 0.02) was associated with rectal contrast studies. Increasing age (odds ratio 1.2, P = 0.008) was associated with colonoscopy.

Routine preoperative imaging was not associated with documented changes in surgical management among trauma patients undergoing ostomy reversal.