Faculty Collaboration Database

Open pelvic fracture and fecal diversion. Arch Surg 1998 Mar;133(3):281-6

Date

03/28/1998

Pubmed ID

9517741

DOI

10.1001/archsurg.133.3.281

Scopus ID

2-s2.0-0031969750 (requires institutional sign-in at Scopus site)   49 Citations

Abstract

BACKGROUND: Mandatory fecal diversion has been advocated as an appropriate measure to prevent infection in the clinical setting of an open pelvic fracture. However, the efficacy of this practice has not been verified by prospective investigation and has received only inconsistent support from retrospective analyses.

OBJECTIVE: To determine whether fecal diversion is associated with a substantially lower incidence of abdominopelvic infectious complications in patients with open pelvic fractures.

DESIGN: Case-control study.

SETTING: University-based tertiary care, level I trauma center.

METHODS: The current study reviews our experience with 60 cases admitted from 1987 to 1993 to Harborview Medical Center, a regional level I trauma center. Data collected on each patient included age, sex, Injury Severity Score, Glasgow Coma Scale, initial heart rate and systolic blood pressure, location and severity of wound, fracture pattern, pelvic stability, time to open reduction internal fixation or external fixation, mortality, use of fecal diversion, and incidence and location of infection. Review of the literature produced an additional 186 patients amenable to analysis.

RESULTS: Fecal diversion was performed in 19 patients, 5 (26%) of whom experienced subsequent abdominopelvic infectious morbidity. Of the remaining 41 patients, 7 patients (17%) experienced infectious complications. The 2 groups (diversion vs no diversion) were comparable with regard to relevant demographic and clinical characteristics of injury severity. Combining the present series with those reported by others gave a composite series of 246 patients. For the composite series, diversion was performed in 70% of patients. Infection developed in 27% of patients who underwent diversion vs 29% in patients who did not. In the present series, only mechanical instability was determined by stepwise logistic regression to be significantly associated with pelvic infection. This association was not altered by diversion status.

CONCLUSIONS: Diversion of the fecal stream to protect open pelvic fractures is not associated with a lower incidence of abdominopelvic infectious complications. Diversion may offer protection to a select group of patients with extensive soft tissue injury or posterior wounds. Mechanical instability was independently associated with infection.

Author List

Woods RK, O'Keefe G, Rhee P, Routt ML Jr, Maier RV

Author

Ronald K. Woods MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Abdominal Abscess
Adult
Case-Control Studies
Colostomy
Defecation
Female
Fractures, Open
Humans
Injury Severity Score
Logistic Models
Male
Pelvic Bones
Treatment Outcome
Wound Infection