Vagus Nerve and Postinjury Inflammatory Response

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Abstract

Objective

To determine whether injured patients who received a vagotomy would have worse outcomes after injury.

Design

Retrospective analysis of the Nationwide Inpatient Sample (NIS) database over 10 years.

Patients

Patients admitted for trauma (primary International Classification of Diseases, Ninth Revision [ICD-9 ] diagnosis codes 800-959) who had a vagotomy (ICD-9 procedure codes 44.00, 44.01, and 44.03) were included. A second cohort of injured patients without vagotomy was extracted and matched 3 to 1 on the following criteria: age, race, sex, concurrent splenectomy, survival risk ratio, payer status, comorbidities, and calendar year.

Main Outcome Measures

The primary outcome measured was in-hospital mortality. Secondary outcomes included septicemia, systemic inflammatory response syndrome, acute respiratory distress syndrome, ulcer disease, length of stay, and total charges.

Results

A total of 56 and 115 patients were included in the vagotomy and control groups, respectively, and were similar in demographic characteristics, comorbidities, and injury severity. We found that the vagotomy group had elevated mortality (27.27% vs 9.57% for controls; P = .003). Patients who received vagotomy also had more septicemia (26.79% vs 3.48%; P < .001) and ulcer disease (71.43% vs 2.61%; P < .001) but not systemic inflammatory response syndrome or acute respiratory distress syndrome. Patients who received vagotomy also had an increased length of hospital stay (36.4 vs 9.6 mean days; P < .001) and total cost ($211 899.90 vs $59 321.64; P < .001).

Conclusions

Vagotomy after traumatic injury is associated with an increase in ulcer disease, septicemia, and mortality. This may reflect a loss of control over the systemic response to injury and warrants further study.

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