1
|
Becnel M, Danner I, Santos MDL, Escobedo LJ, Mohrbacher M, Young J, Patterson R. The utility of a CT grading scale in deciding on surgical intervention for patients with suspected small bowel obstruction. Surg Open Sci 2024; 20:70-76. [PMID: 38946861 PMCID: PMC11214169 DOI: 10.1016/j.sopen.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/09/2024] [Accepted: 05/24/2024] [Indexed: 07/02/2024] Open
Abstract
Background A grading system was developed for computerized tomography (CT) scans evaluating patients with suspected small bowel obstruction (SBO). We hypothesized that patients with a higher grade of suspected SBO on CT scan would be more likely to require surgical intervention. Methods Retrospective chart review of patients who presented to the Emergency Room (ER) who had a CT of the abdomen and pelvis for suspected SBO. Patients were divided into 5 groups: Grade 1 (SBO unlikely), Grade 2 (probable partial or early SBO), Grade 3 (probable high grade SBO), Grade 4 (SBO with changes concerning for ischemia) and Not Graded. Results The CT scans of 655 patients were graded. Of the 22 patients with a grade 1 SBO, only 1 went for surgery (4.5 %). For grade 2 patients, 23 out of 299 had an operation (7.7 %), for grade 3 it was 84 out of 299 (28.1 %) and for grade 4 SBO, 25 out of 35 patients (71.4 %) had surgery. The p value is <0.00001. The three most common intraoperative findings were SBO obstruction from adhesions alone (48 % of cases), followed by incarcerated hernias (12 %) and ischemic bowel (9 %). Only 8 cases out of 133 operations (6 % of total) had no findings at time of surgery other than dilated bowel. Conclusions The CT grading scale for SBO developed at our institution shows excellent correlation between grade and going for surgery, with few negative results, and can be a useful tool among other factors for general surgeons when deciding whether or not to operate on a patient with suspected SBO.
Collapse
Affiliation(s)
- Marianne Becnel
- Noorda College of Osteopathic Medicine, 2162 South 180 East, Provo, UT 84606, USA
| | - Ikaikaolahui Danner
- Noorda College of Osteopathic Medicine, 2162 South 180 East, Provo, UT 84606, USA
| | - Maria De Los Santos
- Noorda College of Osteopathic Medicine, 2162 South 180 East, Provo, UT 84606, USA
| | - Lindsay J. Escobedo
- Noorda College of Osteopathic Medicine, 2162 South 180 East, Provo, UT 84606, USA
| | - Marie Mohrbacher
- Noorda College of Osteopathic Medicine, 2162 South 180 East, Provo, UT 84606, USA
| | - Jacob Young
- Noorda College of Osteopathic Medicine, 2162 South 180 East, Provo, UT 84606, USA
| | - Robert Patterson
- Noorda College of Osteopathic Medicine, 2162 South 180 East, Provo, UT 84606, USA
- Intermountain Health American Fork Hospital, 170 N 1100 E, American Fork, UT 84043, USA
| |
Collapse
|
2
|
Chen B, Sheng W, Wu Z, Ma B, Cao N, Li X, Yang J, Yuan X, Yan L, Zhu G, Zhou Y, Huang Z, Zhu M, Ding X, Du H, Wan Y, Gao X, Cheng X, Xu P, Zhang T, Tao K, Shuai X, Cheng P, Gao Y, Zhang J. Machine learning based peri-surgical risk calculator for abdominal related emergency general surgery: a multicenter retrospective study. Int J Surg 2024; 110:3527-3535. [PMID: 38489557 PMCID: PMC11175782 DOI: 10.1097/js9.0000000000001276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/22/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Currently, there is a lack of ideal risk prediction tools in the field of emergency general surgery (EGS). The American Association for the Surgery of Trauma recommends developing risk assessment tools specifically for EGS-related diseases. In this study, we sought to utilize machine learning (ML) algorithms to explore and develop a web-based calculator for predicting five perioperative risk events of eight common operations in EGS. METHOD This study focused on patients with EGS and utilized electronic medical record systems to obtain data retrospectively from five centers in China. Five ML algorithms, including Random Forest (RF), Support Vector Machine, Naive Bayes, XGBoost, and Logistic Regression, were employed to construct predictive models for postoperative mortality, pneumonia, surgical site infection, thrombosis, and mechanical ventilation >48 h. The optimal models for each outcome event were determined based on metrics, including the value of the Area Under the Curve, F1 score, and sensitivity. A comparative analysis was conducted between the optimal models and Emergency Surgery Score (ESS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and American Society of Anesthesiologists (ASA) classification. A web-based calculator was developed to determine corresponding risk probabilities. RESULT Based on 10 993 patients with EGS, we determined the optimal RF model. The RF model also exhibited strong predictive performance compared with the ESS, APACHE II score, and ASA classification. Using this optimal model, the authors developed an online calculator with a questionnaire-guided interactive interface, catering to both the preoperative and postoperative application scenarios. CONCLUSIONS The authors successfully developed an ML-based calculator for predicting the risk of postoperative adverse events in patients with EGS. This calculator accurately predicted the occurrence risk of five outcome events, providing quantified risk probabilities for clinical diagnosis and treatment.
Collapse
Affiliation(s)
| | - Weiyong Sheng
- Department of Emergency Surgery
- Department of Cardiac Surgery, Yijishan Hospital, Wannan Medical College, Wuhu
| | - Zhixin Wu
- Department of Emergency Surgery
- Department of Emergency Surgery
| | | | - Nan Cao
- School of Computer Science and Technology
| | | | - Jia Yang
- Department of Gastrointestinal Surgery, Central Hospital of Wuhan, Tongji Medical College
| | | | | | | | - Yuanhong Zhou
- Department of Science and Education, Central People’s Hospital of Yichang, Three Gorges University, Yichang
| | | | | | - Xuehui Ding
- Department of Obstetrics and Gynecology, Central Hospital of Hefeng County, Hefeng, People’s Republic of China
| | - Hansong Du
- Department of Gastrointestinal Surgery, Central Hospital of Wuhan, Tongji Medical College
| | - Yanqing Wan
- Department of General Surgery, Union Dongxihu Hospital, Huazhong University of Science and Technology, Wuhan
| | | | | | - Peng Xu
- Department of Emergency Surgery
| | - Teng Zhang
- School of Computer Science and Technology
| | | | | | | | - Yong Gao
- Computer Management Center, Union Hospital
| | | |
Collapse
|
3
|
Mortensen MR, Alouda M, Bond Z, Burcharth J, Finne KF, Jensen TK, Lolle I, Malik T, Ngo-Stuyt L, Nielsen LBJ, Olausson M, Skovsen AP, Tolver MA, Smith HG. One-year outcomes following operative or non-operative management of adhesional small bowel obstruction. BJS Open 2023; 7:zrad103. [PMID: 37837353 PMCID: PMC10576245 DOI: 10.1093/bjsopen/zrad103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/01/2023] [Accepted: 08/23/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND A trial of initial non-operative management is recommended in stable patients with adhesional small bowel obstruction. However, recent retrospective studies have suggested that early operative management may be of benefit in reducing subsequent recurrences. This study aimed to compare recurrence rates and survival in patients with adhesional small bowel obstruction treated operatively or non-operatively. METHODS This was a prospective cohort study conducted at six acute hospitals in Denmark, including consecutive patients admitted with adhesional small bowel obstruction over a 4-month interval. Patients were stratified into two groups according to their treatment (operative versus non-operative) and followed up for 1 year after their index admission. Primary outcomes were recurrence of small bowel obstruction and overall survival within 1 year of index admission. RESULTS A total of 201 patients were included, 118 (58.7 per cent) of whom were treated operatively during their index admission. Patients undergoing operative treatment had significantly better 1-year recurrence-free survival compared with patients managed non-operatively (operative 92.5 per cent versus non-operative 66.6 per cent, P <0.001). However, when the length of index admission was taken into account, patients treated non-operatively spent significantly less time admitted to hospital in the first year (median 3 days non-operative versus 6 days operative, P <0.001). On multivariable analysis, operative treatment was associated with decreased risks of recurrence (HR 0.22 (95 per cent c.i. 0.10-0.48), P <0.001) but an increased all-cause mortality rate (HR 2.48 (95 per cent c.i. 1.13-5.46), P = 0.024). CONCLUSION Operative treatment of adhesional small bowel obstruction is associated with reduced risks of recurrence but increased risk of death in the first year after admission. REGISTRATION NUMBER NCT04750811 (http://www.clinicaltrials.gov).prior (registration date: 11 February 2021).
Collapse
Affiliation(s)
- Marie R Mortensen
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mohammad Alouda
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Zara Bond
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Burcharth
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Katrine F Finne
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Thomas K Jensen
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ida Lolle
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Talha Malik
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - Loan Ngo-Stuyt
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - Liv B J Nielsen
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maria Olausson
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - Anders P Skovsen
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Mette A Tolver
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - Henry G Smith
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| |
Collapse
|
4
|
Nielsen LBJ, Ærenlund MP, Alouda M, Azzam M, Bjerke T, Burcharth J, Dibbern CB, Jensen TK, Jordhøj JQ, Lolle I, Malik T, Ngo-Stuyt L, Nielsen EØ, Olausson M, Skovsen AP, Tolver MA, Smith HG. Real-world accuracy of computed tomography in patients admitted with small bowel obstruction: a multicentre prospective cohort study. Langenbecks Arch Surg 2023; 408:341. [PMID: 37642708 PMCID: PMC10465641 DOI: 10.1007/s00423-023-03084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Small bowel obstruction (SBO) is a common surgical emergency. Previous studies have shown the value computed tomography (CT) scanning in both confirming this diagnosis and identifying indications for urgent surgical intervention, such as strangulated bowel or closed loop obstructions. However, most of the literature is based on retrospective expert review of previous imaging and little data regarding the real-time accuracy of CT reporting is available. Here, we investigated the real-world accuracy of CT reporting in patients admitted with SBO. METHODS This was a multicentre prospective study including consecutive patients admitted with SBO. The primary outcomes were the sensitivity and specificity of CT scanning for bowel obstruction with ischaemia and closed loop obstruction. Data were retrieved from the original CT reports written by on-call radiologists and compared with operative findings. RESULTS One hundred seventy-six patients were included, all of whom underwent CT scanning with intravenous contrast followed by operative management of SBO. Bowel obstruction with ischaemia was noted in 20 patients, with a sensitivity and specificity of CT scanning of 40.0% and 85.5%, respectively. Closed loop obstructions were noted in 26 patients, with a sensitivity and specificity of CT scanning of 23.1% and 98.0%, respectively. CONCLUSIONS The real-world accuracy of CT scanning appears to be lower than previously reported in the literature. Strategies to address this could include the development of standardised reporting schemas and to increase the surgeon's own familiarity with relevant CT features in patients admitted with SBO.
Collapse
Affiliation(s)
- L B J Nielsen
- Abdominalcenter K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - M P Ærenlund
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - M Alouda
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - M Azzam
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - T Bjerke
- Abdominalcenter K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - J Burcharth
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - C B Dibbern
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T K Jensen
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - J Q Jordhøj
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - I Lolle
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T Malik
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - L Ngo-Stuyt
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | - E Ø Nielsen
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Olausson
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | - A P Skovsen
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M A Tolver
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | - H G Smith
- Abdominalcenter K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark.
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark.
| |
Collapse
|
5
|
Reinke CE, Wang H, Thompson K, Paton BL, Sherrill W, Ross SW, Schiffern L, Matthews BD. Impact of COVID-19 on common non-elective general surgery diagnoses. Surg Endosc 2023; 37:692-702. [PMID: 35298704 PMCID: PMC8927521 DOI: 10.1007/s00464-022-09154-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/17/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, public health and hospital policies were enacted to decrease virus transmission and increase hospital capacity. Our aim was to understand the association between COVID-19 positivity rates and patient presentation with EGS diagnoses during the COVID pandemic compared to historical controls. METHODS In this cohort study, we identified patients ≥ 18 years who presented to an urgent care, freestanding ED, or acute care hospital in a regional health system with selected EGS diagnoses during the pandemic (March 17, 2020 to February 17, 2021) and compared them to a pre-pandemic cohort (March 17, 2019 to February 17, 2020). Outcomes of interest were number of EGS-related visits per month, length of stay (LOS), 30-day mortality and 30-day readmission. RESULTS There were 7908 patients in the pre-pandemic and 6771 in the pandemic cohort. The most common diagnoses in both were diverticulitis (29.6%), small bowel obstruction (28.8%), and appendicitis (20.8%). The lowest relative volume of EGS patients was seen in the first two months of the pandemic period (29% and 40% decrease). A higher percentage of patients were managed at a freestanding ED (9.6% vs. 8.1%) and patients who were admitted were more likely to be managed at a smaller hospital during the pandemic. Rates of surgical intervention were not different. There was no difference in use of ICU, ventilator requirement, or LOS. Higher 30-day readmission and lower 30-day mortality were seen in the pandemic cohort. CONCLUSIONS In the setting of the COVID pandemic, there was a decrease in visits with EGS diagnoses. The increase in visits managed at freestanding ED may reflect resources dedicated to supporting outpatient non-operative management and lack of bed availability during COVID surges. There was no evidence of a rebound in EGS case volume or substantial increase in severity of disease after a surge declined.
Collapse
Affiliation(s)
- Caroline E. Reinke
- grid.427669.80000 0004 0387 0597Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Plaza, Suite 300, Charlotte, NC 28205 USA
| | - Huaping Wang
- grid.427669.80000 0004 0387 0597Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Plaza, Suite 300, Charlotte, NC 28205 USA
| | - Kyle Thompson
- grid.427669.80000 0004 0387 0597Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Plaza, Suite 300, Charlotte, NC 28205 USA
| | - B. Lauren Paton
- grid.427669.80000 0004 0387 0597Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Plaza, Suite 300, Charlotte, NC 28205 USA
| | - William Sherrill
- grid.427669.80000 0004 0387 0597Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Plaza, Suite 300, Charlotte, NC 28205 USA
| | - Samuel W. Ross
- grid.427669.80000 0004 0387 0597Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Plaza, Suite 300, Charlotte, NC 28205 USA
| | - Lynnette Schiffern
- grid.427669.80000 0004 0387 0597Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Plaza, Suite 300, Charlotte, NC 28205 USA
| | - Brent D. Matthews
- grid.427669.80000 0004 0387 0597Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Plaza, Suite 300, Charlotte, NC 28205 USA
| |
Collapse
|
6
|
Abstract
Surgical emergencies are common in the critical care setting and require prompt diagnosis and management. Here, we discuss some of the surgical emergencies involving the gastrointestinal, hepatobiliary, and genitourinary sites. In addition, foreign body aspiration and necrotizing soft-tissue infections have been elaborated. Clinicians should be aware of the risk factors, keys examination findings, diagnostic modalities, and medical as well as surgical treatment options for these potentially fatal illnesses.
Collapse
Affiliation(s)
- Vikram Saini
- Division of Infectious Disease (Drs Saini and Bhanot), Division of Pulmonary and Critical Care Medicine (Drs Saini and Ashraf), Department of General Surgery (Dr Babowice), and Division of Trauma Surgery and Surgical Critical Care (Ms Hamilton and Dr Khan), Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | | | | | | | | |
Collapse
|
7
|
Olausson M, Aerenlund MP, Azzam M, Bjerke T, Burcharth JFH, Dibbern CB, Jensen TK, Jordhøj JQ, Lolle I, Ngo-Stuyt L, Nielsen EØ, Nielsen LBJ, Skovsen AP, Tolver MA, Smith HG. Management and short-term outcomes of patients with small bowel obstruction in Denmark: a multicentre prospective cohort study. Eur J Trauma Emerg Surg 2022; 49:1121-1130. [PMID: 36357790 PMCID: PMC9648885 DOI: 10.1007/s00068-022-02171-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/04/2022] [Indexed: 11/12/2022]
Abstract
AIMS The optimal management of small bowel obstruction (SBO) remains a matter of debate and treatment varies internationally. In Denmark, a more surgically aggressive strategy has traditionally been used, but to what extent patient outcomes differ from international reports is unknown. This study aimed to describe the current management and outcomes of patients admitted with SBO in Denmark. METHODS This was a prospective cohort study conducted at six acute hospitals in Denmark over a 4-month period. Patients aged ≥ 18 years with a clinical or radiological diagnosis of SBO were eligible. Primary outcomes were 30 day morbidity and mortality rates. RESULTS 316 patients were included during the study period. The median age was 72 years and 56% were female. Diagnosis was made by computed tomography (CT) in 313 patients (99.1%), with the remaining three diagnosed clinically. Non-operative management was the initial strategy in 152 patients (48.1%) and successful in 119 (78.3%). Urgent surgery was performed in the remaining 164 (51.9%), with a laparoscopic approach used in 84 patients (51.2%). The entire cohort had a 30 day mortality rate of 7.3% and a 30 day morbidity rate of 17.1%. CONCLUSIONS The management of SBO in Denmark differs markedly to previous international reports, with an almost ubiquitous use of CT for diagnosis and a high proportion of patients undergoing urgent surgery. Despite higher rates of surgery, patient outcomes are broadly similar to reports of more conservative strategies, perhaps due to a reduction in delayed operations. TRIAL REGISTRATION Trial registration number: NCT04750811. Trial registration date: 11/02/2021.
Collapse
Affiliation(s)
- M Olausson
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - M P Aerenlund
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Azzam
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - T Bjerke
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J F H Burcharth
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - C B Dibbern
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T K Jensen
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J Q Jordhøj
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - I Lolle
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L Ngo-Stuyt
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - E Ø Nielsen
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L B J Nielsen
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A P Skovsen
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M A Tolver
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - H G Smith
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
8
|
Maraux L, Dammaro C, Gaillard M, Lainas P, Derienne J, Maitre S, Chague P, Rocher L, Dagher I, Tranchart H. Predicting the Need for Surgery in Uncomplicated Adhesive Small Bowel Obstruction: A Scoring Tool. J Surg Res 2022; 279:33-41. [PMID: 35717794 DOI: 10.1016/j.jss.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/08/2022] [Accepted: 05/22/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Nonoperative treatment can be attempted for uncomplicated adhesive small bowel obstruction (ASBO), but carries a risk of delayed surgery. Highlighting initial parameters predicting risk of failure of nonoperative management would be of great interest. METHODS Patients initially managed conservatively for uncomplicated ASBO were retrospectively analyzed. Univariate and multivariate analysis were performed to identify predictive failure's factors. Based on the risk factors, a score was created and then prospectively validated in a different patients' population. RESULTS Among 171 patients included, 98 (57.3%) were successfully managed conservatively. In a multivariate analysis, three independent nonoperative management failure's factors were identified: Charlson Index ≥4 (P = 0.016), distal obstruction (P = 0.009), and maximum small bowel diameter over vertical abdominal diameter ratio >0.34 (P = 0.023). A score of two or three was associated with a risk of surgery of 51.4% or 70.3% in the retrospective analysis and 62.2% or 75% in the validation cohort, respectively. CONCLUSIONS This clinical-radiological score may help guide surgical decision-making in uncomplicated ASBO. A high score (≥2) was predictive of failure of nonoperative management. This tool could assist surgeons to determine who would benefit from early surgery.
Collapse
Affiliation(s)
- Lucien Maraux
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Orsay, France
| | - Carmelisa Dammaro
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Orsay, France
| | - Martin Gaillard
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Orsay, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Orsay, France
| | - Joseph Derienne
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Orsay, France
| | - Sophie Maitre
- Department of Radiology, Antoine-Béclère Hospital, Paris-Saclay University, Orsay, Orsay, France
| | - Pierre Chague
- Department of Radiology, Antoine-Béclère Hospital, Paris-Saclay University, Orsay, Orsay, France
| | - Laurence Rocher
- Department of Radiology, Antoine-Béclère Hospital, Paris-Saclay University, Orsay, Orsay, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Orsay, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Orsay, France.
| |
Collapse
|
9
|
McFadden NR, Brown SK, Howard SM, Utter GH. Validity of the American Association for the Surgery of Trauma Intestinal Obstruction Grading System. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
10
|
Teng CY, Davis BS, Kahn JM, Rosengart MR, Brown JB. Factors associated with potentially avoidable interhospital transfers in emergency general surgery-A call for quality improvement efforts. Surgery 2021; 170:1298-1307. [PMID: 34147261 PMCID: PMC8550996 DOI: 10.1016/j.surg.2021.05.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Emergency general surgery conditions are common, require urgent surgical evaluation, and are associated with high mortality and costs. Although appropriate interhospital transfers are critical to successful emergency general surgery care, the performance of emergency general surgery transfer systems remains unclear. We aimed to describe emergency general surgery transfer patterns and identify factors associated with potentially avoidable transfers. METHODS We performed a retrospective cohort study of emergency general surgery episodes in 8 US states using the 2016 Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases and the American Hospital Association Annual Surveys. We identified Emergency Department-to-Inpatient and Inpatient-to-Inpatient interhospital emergency general surgery transfers. Potentially avoidable transfers were defined as discharge within 72 hours after transfer without undergoing any procedure or operation at the destination hospital. We examined transfer incidence and characteristics. We performed multilevel regression examining patient-level and hospital-level factors associated with potentially avoidable transfers. RESULTS Of 514,410 adult emergency general surgery episodes, 26,281 (5.1%) involved interhospital transfers (Emergency Department-to-Inpatient: 65.0%, Inpatient-to-Inpatient: 35.1%). Over 1 in 4 transfers were potentially avoidable (7,188, 27.4%), with the majority occurring from the emergency department. Factors associated with increased odds of potentially avoidable transfers included self-pay (versus government insurance, odds ratio: 1.26, 95% confidence interval: 1.09-1.45, P = .002), level 1 trauma centers (versus non-trauma centers, odds ratio: 1.24, 95% confidence interval: 1.05-1.47, P = .01), and critical access hospitals (versus non-critical access, odds ratio: 1.30, 95% confidence interval: 1.15-1.47, P < .001). Hospital-level factors (size, trauma center, ownership, critical access, location) accounted for 36.1% of potentially avoidable transfers variability. CONCLUSION Over 1 in 4 emergency general surgery transfers are potentially avoidable. Understanding factors associated with potentially avoidable transfers can guide research, quality improvement, and infrastructure development to optimize emergency general surgery care.
Collapse
Affiliation(s)
- Cindy Y Teng
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Billie S Davis
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jeremy M Kahn
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh PA
| | - Matthew R Rosengart
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Joshua B Brown
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. https://twitter.com/joshua_b_brown
| |
Collapse
|
11
|
Bolívar-Rodríguez MA, Cortés-Ramos MA, Cázarez-Aguilar MA, Rodolfo Fierro-López RFL, Pámanes-Lozano APL. Análisis clínico-tomográfico en obstrucción de intestino delgado por adherencias según el sitio de obstrucción en la tomografía. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. Las adherencias postoperatorias son la causa más frecuente de obstrucción de intestino delgado. La clínica sugiere el diagnóstico, pero de manera poco precisa la causa y el sitio de la obstrucción. La tomografía computarizada contrastada es el estudio óptimo y permite identificar de manera oportuna a los pacientes que requieren intervención quirúrgica. El objetivo de este estudio fue analizar la correlación entre la clínica y el sitio de obstrucción detectado en la tomografía computarizada contrastada de abdomen, en pacientes con sospecha diagnóstica de obstrucción de intestino delgado por adherencias.
Métodos. Estudio prospectivo, transversal y analítico de pacientes con sospecha clínica de obstrucción de intestino delgado por adherencias y antecedentes quirúrgicos y su correlación con el sitio de obstrucción detectado en la tomografía computarizada de abdomen contrastada, de pacientes atendidos entre marzo de 2016 y febrero de 2019 en un hospital de segundo nivel.
Resultados. Se incluyeron 41 pacientes, la media de edad fue de 59 años y el género masculino el más comprometido (68,3 %, n=28); la ausencia de evacuaciones estuvo presente en 97,5 % (p=0,026). La tomografía computarizada contrastada mostró el sitio de obstrucción en 73 % de los pacientes y la localización de la obstrucción más prevalente fue en íleon distal (31,7 %, n=13). Se asoció a leucocitosis (p=0,041) y a dolor más intenso (p=0,049), sin presentar irritación peritoneal.
Conclusión. La obstrucción localizada en el íleon distal se caracterizó por presentar más dolor y mayor recuento leucocitario, sin correlación como factor de riesgo para requerir tratamiento quirúrgico.
Collapse
|
12
|
Emergency General Surgery (EGS) Risk Stratification Scores. CURRENT SURGERY REPORTS 2021. [DOI: 10.1007/s40137-020-00281-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
|
13
|
Scott JW, Staudenmayer K, Sangji N, Fan Z, Hemmila M, Utter G. Evaluating the association between American Association for the Surgery of Trauma emergency general surgery anatomic severity grades and clinical outcomes using national claims data. J Trauma Acute Care Surg 2021; 90:296-304. [PMID: 33214490 DOI: 10.1097/ta.0000000000003030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Emergency general surgery (EGS) encompasses a heterogeneous population of acutely ill patients, and standardized methods for determining disease severity are essential for comparative effectiveness research and quality improvement initiatives. The American Association for the Surgery of Trauma (AAST) has developed a grading system for the anatomic severity of 16 EGS conditions; however, little is known regarding how well these AAST EGS grades can be approximated by diagnosis codes in administrative databases. METHODS We identified adults admitted for 16 common EGS conditions in the 2012 to 2017q3 National Inpatient Sample. Disease severity strata were assigned using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes based on AAST EGS anatomic severity grades. We evaluated whether assigned EGS severity (multiple strata or dichotomized into less versus more complex) were associated with in-hospital mortality, complications, length of stay, discharge disposition, and costs. Analyses were adjusted for age, sex, comorbidities, hospital traits, geography, and year. RESULTS We identified 10,886,822 EGS admissions. The number of anatomic severity strata derived from ICD-9/10-CM codes varied by EGS condition and by year. Four conditions mapped to four strata across all years. Two conditions mapped to four strata with ICD-9-CM codes but only two or three strata with ICD-10-CM codes. Others mapped to three or fewer strata. When dichotomized into less versus more complex disease, patients with more complex disease had worse outcomes across all 16 conditions. The addition of multiple strata beyond a binary measure of complex disease, however, showed inconsistent results. CONCLUSION Classification of common EGS conditions according to anatomic severity is feasible with International Classification of Diseases codes. No condition mapped to five distinct severity grades, and the relationship between increasing grade and outcomes was not consistent across conditions. However, a standardized measure of severity, even if just dichotomized into less versus more complex, can inform ongoing efforts aimed at optimizing outcomes for EGS patients across the nation. LEVEL OF EVIDENCE Prognostic, level III.
Collapse
Affiliation(s)
- John W Scott
- From the Department of Surgery (J.W.S., N.S., M.H.), and Center for Health Outcomes and Policy (J.W.S., N.S., Z.F., M.H.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (K.S.), Stanford University, Stanford; and Outcomes Research Group (G.U.), University of California Davis, Sacramento, California
| | | | | | | | | | | |
Collapse
|
14
|
Comparison of American Association for the Surgery of Trauma grading scale with modified Hinchey classification in acute colonic diverticulitis: A pilot study. J Trauma Acute Care Surg 2020; 88:770-775. [PMID: 32118825 DOI: 10.1097/ta.0000000000002650] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The American Association for the Surgery of Trauma (AAST) developed a severity scale for surgical conditions, including diverticulitis. The Hinchey classification requires operative intervention yet remains the established scoring system for acute diverticulitis. This is a pilot study to compare the AAST grading scale for acute colonic diverticulitis with the traditional Hinchey classification. We hypothesize that the AAST classification scale is equivalent to the Hinchey in predicting outcomes. METHODS This is a retrospective cohort study at an academic medical center. A consecutive sample of patients with acute diverticulitis and computed tomography imaging was reviewed. Chart review identified demographic and physiologic data with interventional and clinical outcomes. Each computed tomography scan was assigned AAST and modified Hinchey classification scores by a radiologist. Multivariate regression and receiver operating characteristic curve analysis compared six outcomes: need for procedure, complication, intensive care unit (ICU) admission, length of stay, 30-day readmission, and mortality. RESULTS One hundred twenty-nine patients were included. Of the total patients, 42.6% required procedural intervention, 21.7% required ICU admission, 18.6% were readmitted, and 6.2% died. Both AAST and Hinchey predicted the need for operation (AAST odds ratios, 1.55, 12.7, 18.09, and 77.24 for stages 2-5; Hinchey odds ratios, 8.85, 11.49, and 22.9 for stages 1b-3, stage 4 predicted perfectly). The need for operation c-statistics (area under the curve) for AAST and Hinchey was 0.80 and 0.83 for Hinchey and AAST, respectively (p = 0.35). The complication c-statistics curve for AAST and Hinchey was 0.83 and 0.80, respectively (p = 0.33). The AAST and Hinchey scores were less predictive for ICU admission, readmission, and mortality with c-statistics of less than 0.80. CONCLUSION The AAST grading of acute diverticulitis is equivalent to the modified Hinchey classification in predicting procedural intervention and complications. The AAST system may be preferable to Hinchey because it can be applied preoperatively. Although this pilot study demonstrated that the AAST score predicts surgical need, a larger study is required to evaluate the AAST score for other outcomes. LEVEL OF EVIDENCE Prognostic and epidemiological study, level III.
Collapse
|
15
|
Detz DJ, Podrat JL, Muniz Castro JC, Lee YK, Zheng F, Purnell S, Pei KY. Small bowel obstruction. Curr Probl Surg 2020; 58:100893. [PMID: 34130796 DOI: 10.1016/j.cpsurg.2020.100893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | - Yoon K Lee
- Houston Methodist Hospital, Houston, Texas
| | - Feibi Zheng
- Weill Cornell Medicine, Houston Methodist Hospital, Houston, Texas
| | | | | |
Collapse
|
16
|
Validation of the American Association for the Surgery of Trauma grading system for acute mesenteric ischemia-More than anatomic severity is needed to determine risk of mortality. J Trauma Acute Care Surg 2020; 88:671-676. [PMID: 32317577 DOI: 10.1097/ta.0000000000002592] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Acute mesenteric ischemia (AMI) is a highly morbid disease with a diverse etiology. The American Association for the Surgery of Trauma (AAST) proposed disease-specific grading scales intended to quantify severity based upon clinical, imaging, operative, and pathology findings. This grading scale has not been yet been validated for AMI. The goal of this study was to evaluate the correlation between the grading scale and complication severity. METHODS Patients for this single center retrospective chart review were identified using diagnosis codes for AMI (ICD10-K55.0, ICD9-557.0). Inpatients >17 years old from the years 2008 to 2015 were included. The AAST grades (1-5) were assigned after review of clinical, imaging (computed tomography), operative and pathology findings. Two raters applied the scales independently after dialog with consensus on a learning set of cases. Mortality and Clavien-Dindo complication severity were recorded. RESULTS A total of 221 patients were analyzed. Overall grade was only weakly correlated with Clavien-Dindo complication severity (rho = 0.27) and mortality (rho = 0.21). Computed tomography, pathology, and clinical grades did not correlate with mortality or outcome severity. There was poor interrater agreement between overall grade. A mortality prediction model of operative grade, use of vasopressors, preoperative serum creatinine and lactate levels showed excellent discrimination (c-index = 0.93). CONCLUSION In contrast to early application of other AAST disease severity scales, the AMI grading scale as published is not well correlated with outcome severity. The AAST operative grade, in conjunction with vasopressor use, creatinine, and lactate were strong predictors of mortality. LEVEL OF EVIDENCE Prognostic study, III.
Collapse
|
17
|
Hernandez MC, Finnesgard EJ, Shariq OA, Knight A, Stephens D, Aho JM, Kim BD, Schiller HJ, Zielinski MD. Disease Severity and Cost in Adhesive Small Bowel Obstruction. World J Surg 2020; 43:3027-3034. [PMID: 31555867 DOI: 10.1007/s00268-019-05148-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Adhesive small bowel obstruction (ASBO) severity has been associated with important clinical outcomes. However, the impact of ASBO severity on hospitalization cost is unknown. The American Association for the Surgery of Trauma (AAST) developed an Emergency General Surgery (EGS) disease severity grading system for ASBO. We stratified patients' ASBO severity and captured hospitalization costs hypothesizing that increased disease severity would correlate with greater costs. METHODS This was a single-center study of hospitalized adult patients with SBO during 2015-2017. Clinical data and estimated total cost (direct + indirect) were abstracted. AAST EGS grades (I-IV) stratified disease severity. Costs were normalized to the median grade I cost. Univariate and multivariate analyses evaluated the relationship between normalized cost and AAST EGS grade, length of hospital and ICU stay, operative time, and Charlson comorbidity index. RESULTS There were 214 patients; 119 (56%) were female. AAST EGS grades included: I (62%, n = 132), II (23%, n = 49), III (7%, n = 16), and IV (8%, n = 17). Relative to grade I, median normalized cost increased by 1.4-fold for grade II, 1.6-fold for grade III, and 4.3-fold for grade IV disease. No considerable differences in patient comorbidity between grades were observed. Pair-wise comparisons demonstrated that grade I disease cost less than higher grades (corrected p < 0.001). Non-operative management was associated with lower normalized cost compared to operative management (1.1 vs. 4.5, p < 0.0001). In patients who failed non-operative management, normalized cost was increased 7.2-fold. Collectively, the AAST EGS grade correlated well with cost (Spearman's p = 0.7, p < 0.0001). After adjustment for covariates, AAST EGS grade maintained a persistent relationship with cost. CONCLUSION Increasing ASBO severity is independently associated with greater costs. Efforts to identify and mitigate costs associated with this burdensome disease are warranted. LEVEL OF EVIDENCE III, economic/decision.
Collapse
Affiliation(s)
- Matthew C Hernandez
- Division of Trauma, Critical Care and General Surgery, St. Mary's Hospital, Mayo Clinic, Mary Brigh 2-810, 1216 Second Street SW, Rochester, MN, 55902, USA
| | | | - Omair A Shariq
- Division of Trauma, Critical Care and General Surgery, St. Mary's Hospital, Mayo Clinic, Mary Brigh 2-810, 1216 Second Street SW, Rochester, MN, 55902, USA
| | - Ariel Knight
- Division of Trauma, Critical Care and General Surgery, St. Mary's Hospital, Mayo Clinic, Mary Brigh 2-810, 1216 Second Street SW, Rochester, MN, 55902, USA
| | - Daniel Stephens
- Division of Trauma, Critical Care and General Surgery, St. Mary's Hospital, Mayo Clinic, Mary Brigh 2-810, 1216 Second Street SW, Rochester, MN, 55902, USA
| | - Johnathon M Aho
- Division of Trauma, Critical Care and General Surgery, St. Mary's Hospital, Mayo Clinic, Mary Brigh 2-810, 1216 Second Street SW, Rochester, MN, 55902, USA
| | - Brian D Kim
- Division of Trauma, Critical Care and General Surgery, St. Mary's Hospital, Mayo Clinic, Mary Brigh 2-810, 1216 Second Street SW, Rochester, MN, 55902, USA
| | - Henry J Schiller
- Division of Trauma, Critical Care and General Surgery, St. Mary's Hospital, Mayo Clinic, Mary Brigh 2-810, 1216 Second Street SW, Rochester, MN, 55902, USA
| | - Martin D Zielinski
- Division of Trauma, Critical Care and General Surgery, St. Mary's Hospital, Mayo Clinic, Mary Brigh 2-810, 1216 Second Street SW, Rochester, MN, 55902, USA.
| |
Collapse
|
18
|
Lee MJ, Sayers AE, Drake TM, Marriott PJ, Anderson ID, Bach SP, Bradburn M, Hind D, Verjee A, Fearnhead NS. National prospective cohort study of the burden of acute small bowel obstruction. BJS Open 2019; 3:354-366. [PMID: 31183452 PMCID: PMC6551410 DOI: 10.1002/bjs5.50136] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/27/2018] [Indexed: 12/21/2022] Open
Abstract
Background Small bowel obstruction is a common surgical emergency, and is associated with high levels of morbidity and mortality across the world. The literature provides little information on the conservatively managed group. The aim of this study was to describe the burden of small bowel obstruction in the UK. Methods This prospective cohort study was conducted in 131 acute hospitals in the UK between January and April 2017, delivered by trainee research collaboratives. Adult patients with a diagnosis of mechanical small bowel obstruction were included. The primary outcome was in‐hospital mortality. Secondary outcomes included complications, unplanned intensive care admission and readmission within 30 days of discharge. Practice measures, including use of radiological investigations, water soluble contrast, operative and nutritional interventions, were collected. Results Of 2341 patients identified, 693 (29·6 per cent) underwent immediate surgery (within 24 h of admission), 500 (21·4 per cent) had delayed surgery after initial conservative management, and 1148 (49·0 per cent) were managed non‐operatively. The mortality rate was 6·6 per cent (6·4 per cent for non‐operative management, 6·8 per cent for immediate surgery, 6·8 per cent for delayed surgery; P = 0·911). The major complication rate was 14·4 per cent overall, affecting 19·0 per cent in the immediate surgery, 23·6 per cent in the delayed surgery and 7·7 per cent in the non‐operative management groups (P < 0·001). Cox regression found hernia or malignant aetiology and malnutrition to be associated with higher rates of death. Malignant aetiology, operative intervention, acute kidney injury and malnutrition were associated with increased risk of major complication. Conclusion Small bowel obstruction represents a significant healthcare burden. Patient‐level factors such as timing of surgery, acute kidney injury and nutritional status are factors that might be modified to improve outcomes.
Collapse
Affiliation(s)
- M J Lee
- Department of General Surgery Northern General Hospital Sheffield UK.,South Yorkshire Surgical Research Group Sheffield UK
| | - A E Sayers
- South Yorkshire Surgical Research Group Sheffield UK.,Department of General Surgery Doncaster Royal Infirmary Doncaster UK
| | - T M Drake
- South Yorkshire Surgical Research Group Sheffield UK.,Department of Clinical Surgery University of Edinburgh Edinburgh UK
| | - P J Marriott
- Department of General Surgery Warwick Hospital Warwick UK.,Department of General Surgery Salford Royal Infirmary Salford UK
| | - I D Anderson
- West Midlands Research Collaborative, Academic Department of Surgery Queen Elizabeth Hospital Birmingham UK
| | - S P Bach
- Academic Department of Surgery Queen Elizabeth Hospital Birmingham UK
| | - M Bradburn
- Clinical Trials and Research Unit University of Sheffield Sheffield UK
| | - D Hind
- Clinical Trials and Research Unit University of Sheffield Sheffield UK
| | - A Verjee
- Patient Representative, Association of Coloproctology of Great Britain and Ireland Patient Liaison Group London UK
| | - N S Fearnhead
- Department of Surgery Addenbrooke's Hospital Cambridge UK
| | | |
Collapse
|