About

Alexander Lorenzo Colonna is an Associate Professor of Surgery at the University of Utah, specializing in Acute Care Surgery, which includes Trauma Surgery, Emergency General Surgery, and Surgical Critical Care. His clinical practice encompasses the University Hospital SICU and the University Trauma and Emergency Surgery (UTES) service. Dr. Colonna has a particular interest in complex abdominal wall hernias and basic general surgical pathology through his General Surgery Clinic. Originally from South Carolina, he completed his General Surgery Residency at East Tennessee State University and further specialized with Fellowships in Surgical Critical Care and Acute Care Surgery at Wake Forest University. Since joining the University of Utah faculty in 2012 after a brief period in private practice, he has contributed significantly to medical education, previously directing surgery clerkships and currently serving as the program director of the SCC/ACS fellowships. His research interests include cost-effectiveness analysis, educational research with a focus on simulation, and trauma and acute care surgery. Dr. Colonna is also the inaugural Emergency Surgery Medical Director and is working toward EGS verification by the American College of Surgeons. Additionally, he serves as chair of the Utah State COT and has a distinguished military career as an Army Reservist since 2003, holding the rank of Lieutenant Colonel and serving as Trauma Medical Director for Operation Inherent Resolve during his deployment to Iraq in 2023-2024.

Research topics

• Medicine
• Surgery
• Anesthesia
• Risk analysis (engineering)
• Emergency medicine
• Internal medicine

Selected publications

• Navigating the danger zone: GoNoGoNet can be used to enhance safety and skill in laparoscopic cholecystectomy

  Global Surgical Education - Journal of the Association for Surgical Education · 2026-02-09

  articleOpen access

  Abstract Purpose Laparoscopic cholecystectomy (LC) carries a risk of bile duct injury, mitigated by achieving a critical view of safety. GoNoGoNet, an open-source artificial intelligence model, aims to support surgical training by identifying safe (“Go”) and unsafe (“NoGo”) dissection zones in real time. We sought to evaluate the feasibility of using GoNoGoNet overlays to annotate unsafe dissection behavior during LC. We hypothesized that GoNoGoNet overlays would enable reliable annotation of unsafe dissection behavior during LC, with higher surgeon technical skill associated with fewer NoGo zone intrusions. Methods LC videos were collected under a quality improvement protocol at a safety-net hospital. The hepatocystic triangle dissection phase was isolated and manually annotated for subsequent GoNoGoNet overlay application. The primary outcome was any surgical tool invasion into the NoGo zone. Invasion events were assessed as raw counts, providing a direct and consistent measure of discrete safety–critical errors. Two trained graders assessed all videos using the Global Operative Assessment of Laparoscopic Skills (GOALS), tool invasion counts, and the Parkland Grading Scale (PGS) to adjust for case complexity. Interrater reliability was measured using intraclass correlation coefficients. Spearman’s rank correlation was used to examine the relationship between GOALS scores and NoGo intrusions. A multivariable linear regression model predicted NoGo intrusions based on GOALS scores, controlling for complexity. Results Out of 59 videos, 40 videos were classified as low-complexity (PGS 1–2), and 19 as high-complexity (PGS 3–5). Strong interrater agreement was observed for GOALS (ICC = 0.94), tool invasion (ICC = 0.82), and PGS grades (ICC = 0.89). GOALS scores and NoGo intrusions were significantly negatively correlated (R = − 0.59; p < 0.05), suggesting higher technical skill was associated with fewer unsafe dissection events. This finding was consistent across low- (R = − 0.63; p < 0.05) and high-complexity cases (R = − 0.54; p < 0.05). GOALS score was a significant negative predictor of NoGo intrusions in multivariable regression (β = − 1.91; 95% CI [− 2.69, − 1.13]; p < 0.001; R 2 = 0.305), while case complexity was not significant ( p = 0.754). Conclusion GoNoGoNet shows promise as a training tool for enhancing LC safety. The use of its overlays to annotate unsafe dissections revealed an inverse correlation with surgical skill level, regardless of case complexity. Further studies are warranted to validate its broader application in minimally invasive surgical education.

  PublisherOA PDFDOI

• Risk factors for carnitine deficiency in critically ill adults: A descriptive cross‐sectional study

  Journal of Parenteral and Enteral Nutrition · 2026-01-07

  articleOpen access

  BACKGROUND: Critical illness is a risk factor for carnitine deficiency. Carnitine deficiency may result in serious medical complications and poor clinical outcomes. This study aimed to identify the prevalence and potential predictors of carnitine deficiency. METHODS: This was a descriptive cross-sectional study conducted in a convenience sample of 144 critically ill adults admitted to a surgical or cardiovascular intensive care unit at the University of Utah Hospital, with serum carnitine levels measured from January 1, 2022, to December 31, 2024. Binary and multivariable logistic regression models were constructed to explore potential predictors of carnitine deficiency, which was defined as a free serum carnitine level <36 µmol/L. RESULTS: The mean age of patients was 56.5 years; 41.7% of the sample had carnitine deficiency. For each unit decrease in body mass index, the odds of developing carnitine deficiency increased by 5% compared with maintaining normal free carnitine status (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.9-0.99). Those prescribed continuous renal replacement therapy were 2.43 times more likely to develop carnitine deficiency than those not on continuous renal replacement therapy (OR, 2.43; 95% CI, 1.12-5.25). CONCLUSION: A high proportion of our study population had carnitine deficiency. Continuous renal replacement therapy and a lower body mass index were significant predictors in the multivariable model. Female sex and a history of chronic kidney disease may warrant further exploration based on significance in the univariable analysis.

  PublisherOA PDFDOI

• Cholecystostomy Indications and Outcomes: Which Patients Will Benefit?

  Current Surgery Reports · 2025-01-08

  articleOpen accessSenior author

  Abstract Purpose of Review Percutaneous cholecystostomy (PCT) is a technique used to treat acute cholecystitis in patients who are not surgical candidates for cholecystectomy at the time of presentation. Usage has increased over time and the procedure is nearly always technically successful. We reviewed recent literature to assess for new developments in outcomes and indications for PCT placement. Recent Findings Newer data has questioned whether outcomes for patients who get a PCT are better than those managed medically or with cholecystectomy. Multiple studies have shown no difference in mortality between different treatment strategies, and patients who get PCT placement tend to incur higher healthcare utilization. Summary While PCT is a safe alternative for source control in critically ill patients with cholecystitis, interval cholecystectomy should be performed when possible. Further prospective data is needed to assess long term outcomes and quality of life for patients with PCT.

  PublisherOA PDFDOI

• Will the bleeding stop? A commentary on: Effect of anticoagulation on isolated traumatic brain injury mortality using TQIP database: a propensity score analysis stratified by head injury severity

  Trauma Surgery & Acute Care Open · 2025-10-01

  articleOpen accessSenior author

  Traumatic brain injury (TBI) continues to represent a major source of trauma-related morbidity and mortality in the USA, accounting for nearly one-third of all injury deaths.

  PublisherOA PDFDOI

• Current management of malignant bowel obstructions: a survey of acute care surgeons and surgical oncologists

  Trauma Surgery & Acute Care Open · 2021-06-01 · 9 citations

  articleOpen accessSenior author

  BACKGROUND: Malignant small bowel obstructions (MSBOs) are one of the most challenging problems surgeons encounter, and evidence-based treatment recommendations are lacking. We hypothesized that current opinions on MSBO management differ between acute care surgeons (ACSs) and surgical oncologists (SOs). METHODS: We developed three case scenarios describing patients with previously treated cancer who developed an MSBO. Each case had five to six alternate scenarios, intended to capture the heterogeneity of MSBO presentations. Members of the Society of Surgical Oncology, the American Society of Peritoneal Surface Malignancies, and the Eastern Association for the Surgery of Trauma were asked how likely they would be to offer surgical treatment in each scenario. Responses were analyzed for factors associated with the likelihood surgeons would offer surgical management. RESULTS: 316 surgeons completed the survey: 119 (37.7%) SOs and 197 (62.3%) ACSs. Overall, SOs were nearly twice as likely as ACSs to recommend surgical management. The largest differences between provider groups were seen in patients with an increased metastatic burden. In a patient with MSBO with metastatic colon cancer, both SOs (95.8%) and ACSs (94.4%) were likely or very likely to offer an operation (p=0.587); however, this fell to 91.6% and 77.7%, respectively, when this patient had multiple hepatic metastases (p=0.001). All surgeons were less likely to offer surgery to patients with multiple sites of obstruction, recurrent MSBO, and shorter disease-free intervals. DISCUSSION: Opinions on MSBO management differ based on surgeon training and experience. Multidisciplinary management of patients with MSBO should be offered when available and increased emphasis placed on determining optimal management guidelines across specialties. LEVEL OF EVIDENCE: Level IV Epidemiologic.

  PublisherOA PDFDOI

• Perioperative Evaluation and Decision-Making, When to Operate and by Which Approach: Tube Cholecystostomy

  2021-01-01

  book-chapterSenior author
  PublisherDOI

• Stop flailing: The impact of bicortically displaced rib fractures on pulmonary outcomes in patients with chest trauma — an American Association for the Surgery of Trauma multi-institutional study

  Journal of Trauma and Acute Care Surgery · 2020 · 18 citations

  • Medicine
  • Surgery
  • Internal medicine

  BACKGROUND: Current evaluation of rib fractures focuses almost exclusively on flail chest with little attention on bicortically displaced fractures. Chest trauma that is severe enough to cause fractures leads to worse outcomes. An association between bicortically displaced rib fractures and pulmonary outcomes would potentially change patient care in the setting of trauma. We tested the hypothesis that bicortically displaced fractures were an important clinical marker for pulmonary outcomes in patients with nonflail rib fractures. METHODS: This nine-center American Association for the Surgery of Trauma multi-institutional study analyzed adults with two or more rib fractures. Admission computerized tomography scans were independently reviewed. The location, degree of rib fractures, and pulmonary contusions were categorized. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of pneumonia, acute respiratory distress syndrome (ARDS), and tracheostomy. Analyses were performed in nonflail patients and also while controlling for flail chest to determine if bicortically displaced fractures were independently associated with outcomes. RESULTS: Of the 1,110 patients, 103 (9.3%) developed pneumonia, 78 (7.0%) required tracheostomy, and 30 (2.7%) developed ARDS. Bicortically displaced fractures were present in 277 (25%) of patients and in 206 (20.3%) of patients without flail chest. After adjusting for patient demographics, injury, and admission physiology, negative pulmonary outcomes occurred over twice as frequently in those with bicortically displaced fractures without flail chest (n = 206) when compared with those without bicortically displaced fractures-pneumonia (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-3.6), ARDS (OR, 2.6; 95% CI, 1.0-6.8), and tracheostomy (OR, 2.7; 95% CI, 1.4-5.2). When adjusting for the presence of flail chest, bicortically displaced fractures remained an independent predictor of pneumonia, tracheostomy, and ARDS. CONCLUSION: Patients with bicortically displaced rib fractures are more likely to develop pneumonia, ARDS, and need for tracheostomy even when controlling for flail chest. Future studies should investigate the utility of flail chest management algorithms in patients with bicortically displaced fractures. LEVEL OF EVIDENCE: Prognostic and epidemiological study, level III.

  PublisherDOI

• Reducing the pain: A cost-effectiveness analysis of transversus abdominis plane block using liposomal bupivacaine for outpatient laparoscopic ventral hernia repair

  Surgery Open Science · 2020 · 9 citations

  1st authorCorresponding
  • Medicine
  • Anesthesia
  • Surgery

  BACKGROUND: Transversus abdominis plane block with liposomal bupivacaine has been studied as an effective method of reducing the need for postoperative opioids and increasing same-day discharge rates. However, less is known about the cost-effectiveness of this strategy relative to opioids alone for hernia repair. We performed an economic evaluation of these strategies using a computer simulation model. METHODS: A decision tree was constructed to determine cost-effectiveness as measured by incremental cost-effectiveness ratios per quality-adjusted life-year. Base-case costs, quality-adjusted life-year values, and probabilities were derived from published studies and Medicare fee schedules. For input parameters for which we could not find values in the published literature, we used expert opinion. A 1-month time horizon was selected to focus on the immediate postoperative period. Finally, we performed 1-way, 2-way, and probabilistic sensitivity analyses. RESULTS: The liposomal bupivacaine transversus abdominis plane block was a dominant strategy yielding a $456.75 decrease in cost and an 0.1 increase in quality-adjusted life-years relative to opioids alone. In 1-way sensitivity analysis of cost incremental cost-effectiveness ratio, values were most sensitive to variations in the amount saved by same-day discharge and the cost of bupivacaine. In probabilistic sensitivity analyses, transversus abdominis plane strategy was cost-effective at a willingness-to-pay threshold of $50,000/quality-adjusted life-year in 94.5% of iterations and at a willingness-to-pay threshold of $100,000/quality-adjusted life-year in 97.1% of iterations. CONCLUSION: The use of liposomal bupivacaine transversus abdominis plane block resulted in cost savings and improved quality-adjusted life-years in base-case analyses and was cost-effective at conventional willingness-to-pay thresholds in the majority of iterations in probabilistic sensitivity analyses.

  PublisherDOI

• Reducing the Pain: A Cost Effectiveness Analysis of Transversus Abdominis Plane Block Using Liposomal Bupivacaine for Outpatient Laparoscopic Ventral Hernia Repair

  SSRN Electronic Journal · 2019-01-01

  articleOpen access1st authorCorresponding
  PublisherDOI

• Telephone Follow-Up for Emergency General Surgery Procedures: Safety and Implication for Health Resource Use

  Journal of the American College of Surgeons · 2019-10-23 · 9 citations

  article

  BACKGROUND: It is unknown whether replacing clinic follow-up visits with telephone follow-up for low-risk core emergency general surgery (cEGS) procedures is safe. We measured the efficacy of telephone follow-up to determine if it could safely reduce the need for routine postoperative clinic visits in this population. STUDY DESIGN: Low-risk nonelective laparoscopic appendectomy, laparoscopic cholecystectomy, umbilical hernia, and inguinal hernia repair patients received telephone follow-up for symptoms concerning for surgical complication within 10 days of discharge. Clinic appointments were made if critical thresholds were reached. Outcomes of interest included rates of completed telephone screens, clinic visits avoided, and missed complications at 30 days postoperatively. RESULTS: Of 402 patients screened, 62 (15.4%) were scheduled for a clinic visit due to threshold responses and 27 (6.7%) were scheduled per patient request, while 275 (68.4%) patients screened negative and did not attend a clinic visit. One hundred sixty-three (59.3%) of the negative screen cohort were contacted after 30 days. Nine (5.5%) patients in this cohort were diagnosed with low-grade complications; no high-grade (Clavien-Dindo ≥ 3) complications were missed by telephone screening. Twenty surgery-related complications were identified in the full patient population; early telephone screening successfully identified the single high-grade complication. CONCLUSIONS: Post-discharge telephone follow-up in cEGS patients reduced the need for clinic follow-up visits by 68%. Missed complications were infrequent and low grade; telephone screening identified the single high-grade complication. Telephone follow-up for low-risk EGS patients is safe and increases efficiency of postoperative resource use.

  PublisherDOI

Frequent coauthors

• Ernest E. Moore

  University of Colorado Denver

  692 shared

• Clay Cothren Burlew

  484 shared

• Joel M. Bartfield

  480 shared

• John A. Kellum

  University of Pittsburgh

  472 shared

• Nattachai Srisawat

  Thai Red Cross Society

  470 shared

• Charles S. Brudney

  468 shared

• Susanna Price

  Harefield Hospital

  458 shared

• Jonathan R. Egan

  342 shared

Education

• M.D.

  East Tennessee State University

• Other, Surgical Critical Care and Acute Care Surgery

  Wake Forest University

Awards & honors

• Fellow of the American College of Surgeons (FACS)
• Inaugural Emergency Surgery Medical Director