Morbidity and timing of colostomy closure in trauma patients

The reported morbidity of colostomy closure in trauma patients varies from 5 to 27 per cent. Low morbidity rates are cited as a factor favouring colostomy creation and against expanded indications for primary repair in the treatment of colonic injuries. In order to assess the morbidity of colostomy closure, we reviewed all colonic injuries from 1979 to 1991 at our institutions. In all, 86 trauma patients who underwent colostomy creation and closure were identified. There were 82 men and four women with an age range of 16 to 74 years (mean 28.1 years). Of these, 95 per cent (N = 82) resulted from penetrating trauma. Of the patients, 63 per cent (N = 54) received end colostomies and 81 per cent (N = 70) of the patients had associated injuries. Of the patients, 38 per cent (N = 33) had a complication with their initial operation. There were no deaths after colostomy closure, but a total morbidity of 24.4 per cent (N = 21) was noted. There were 11 anastomotic complications (two of which required repeat laparotomy) and nine wound infections. The average length of stay was 10.4 days. Morbidity was concentrated in the group who had complications at their initial hospitalization. This was especially true if these patients underwent closure earlier than 3 months after injury. Conversely, if the first operation was uncomplicated, waiting longer than 3 months to perform colostomy closure did not improve results further.