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Trang K, Fung BSC, Lamb T, Moloo H, Wick EC. Reducing Carbon Footprint in Travel to the American Society of Colon and Rectal Surgeons Annual Meeting: Striking a Balance Between Environmental Impact and Collaborative Opportunities. Dis Colon Rectum 2024; 67:197-199. [PMID: 37889946 DOI: 10.1097/dcr.0000000000003037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Affiliation(s)
- Karen Trang
- Department of Surgery, University of California San Francisco, San Francisco, California
| | | | - Tyler Lamb
- Department of Surgery, University of Ottawa, Ontario, Canada
| | - Husein Moloo
- Department of Surgery, University of Ottawa, Ontario, Canada
| | - Elizabeth C Wick
- Department of Surgery, University of California San Francisco, San Francisco, California
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Fung BSC, Behman R, Nguyen MA, Nathens AB, Look Hong NJ, Pechlivanoglou P, Karanicolas PJ. Longer Trials of Non-operative Management for Adhesive Small Bowel Obstruction Are Associated with Increased Complications. J Gastrointest Surg 2020; 24:890-898. [PMID: 31062274 DOI: 10.1007/s11605-019-04156-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/05/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current guidelines for the management of adhesive small bowel obstruction suggest a limited trial of non-operative management, often of 3-5 days. A longer delay to operation may worsen post-operative outcomes in patients who ultimately require operation. Our objective was to evaluate the impact of time to operation on post-operative outcomes in patients who undergo operation following a trial of non-operative management for adhesive small bowel obstruction. METHODS We used health administrative data to identify patients with adhesive small bowel obstruction who underwent operative management following a trial of non-operative management from 2005 to 2014 in the province of Ontario, Canada. We used multivariable logistic regression to examine the relationship between the time from admission to operation with rates of 30-day mortality, serious complication, and bowel resection. RESULTS Three thousand five hundred sixty-three patients underwent operation after a trial of non-operative management for adhesive small bowel obstruction. Older patients, patients with a high comorbidity burden, and patients with a lower socioeconomic status were more likely to experience a longer pre-operative period. After adjusting for covariates, each additional day from admission to operation increased odds of serious complication (OR = 1.07, 95% CI = 1.03-1.11) and bowel resection (OR = 1.06, 95% CI = 1.03-1.98). Longer times to operation were not associated with greater adjusted odds of 30-day mortality. CONCLUSION Each additional day from admission to operation is associated with greater odds of adverse outcomes. Clinical practice guidelines should emphasize strategies that identify patients who will ultimately require operation.
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Affiliation(s)
- Benjamin S C Fung
- Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, T2-016, Toronto, ON, M4N3M5, Canada
| | - Ramy Behman
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - May-Anh Nguyen
- Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, T2-016, Toronto, ON, M4N3M5, Canada
| | - Avery B Nathens
- Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, T2-016, Toronto, ON, M4N3M5, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Nicole J Look Hong
- Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, T2-016, Toronto, ON, M4N3M5, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Petros Pechlivanoglou
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Paul J Karanicolas
- Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, T2-016, Toronto, ON, M4N3M5, Canada.
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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