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Trials of nonoperative management exceeding 3 days are associated with increased morbidity in patients undergoing surgery for uncomplicated adhesive small bowel obstruction.

Publication ,  Journal Article
Keenan, JE; Turley, RS; McCoy, CC; Migaly, J; Shapiro, ML; Scarborough, JE
Published in: J Trauma Acute Care Surg
June 2014

BACKGROUND: Controversy exists over how long trials of nonoperative management should be pursued in patients with uncomplicated adhesive small bowel obstructions (ASBOs) before deciding to proceed with surgery. The purpose of this study was to determine the effect of incremental delays in surgery on the 30-day postoperative outcomes of patients undergoing surgery for uncomplicated ASBO. METHODS: American College of Surgeons National Surgical Quality Improvement Program 2005-2011 data were used to identify patients with uncomplicated ASBO in whom a trial of nonoperative management was attempted. Multivariate logistic or linear regression model was created to determine the independent association between the length of preoperative hospitalization and 30-day postoperative outcomes after adjustment for patient- and procedure-related factors. RESULTS: A total of 9,297 patients were included in the study. The 30-day postoperative mortality and overall morbidity rates of the entire cohort were 4.4% and 29.6%, respectively. The median postoperative length of hospitalization was 7 days (interquartile range, 5-11 days). After risk adjustment, there was no association between preoperative length of hospitalization and 30-day postoperative mortality. In contrast, increased 30-day overall morbidity was observed in patients who received their operation after a preoperative length of hospitalization of 3 days compared with earlier in their hospitalization. Furthermore, an increased postoperative length of hospitalization was found in patients who were operated on after a preoperative length of hospitalization of 4 days. CONCLUSION: Trials of nonoperative management for uncomplicated ASBO exceeding 3 days are associated with increased morbidity and postoperative length of hospitalization. These trials should therefore generally not extend beyond this time point. LEVEL OF EVIDENCE: Therapeutic study, level IV.

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Published In

J Trauma Acute Care Surg

DOI

EISSN

2163-0763

Publication Date

June 2014

Volume

76

Issue

6

Start / End Page

1367 / 1372

Location

United States

Related Subject Headings

  • Tissue Adhesions
  • Time Factors
  • Retrospective Studies
  • Preoperative Care
  • Postoperative Complications
  • Morbidity
  • Male
  • Length of Stay
  • Intestine, Small
  • Intestinal Obstruction
 

Citation

APA
Chicago
ICMJE
MLA
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Keenan, J. E., Turley, R. S., McCoy, C. C., Migaly, J., Shapiro, M. L., & Scarborough, J. E. (2014). Trials of nonoperative management exceeding 3 days are associated with increased morbidity in patients undergoing surgery for uncomplicated adhesive small bowel obstruction. J Trauma Acute Care Surg, 76(6), 1367–1372. https://doi.org/10.1097/TA.0000000000000246
Keenan, Jeffrey E., Ryan S. Turley, Christopher Cameron McCoy, John Migaly, Mark L. Shapiro, and John E. Scarborough. “Trials of nonoperative management exceeding 3 days are associated with increased morbidity in patients undergoing surgery for uncomplicated adhesive small bowel obstruction.J Trauma Acute Care Surg 76, no. 6 (June 2014): 1367–72. https://doi.org/10.1097/TA.0000000000000246.
Keenan JE, Turley RS, McCoy CC, Migaly J, Shapiro ML, Scarborough JE. Trials of nonoperative management exceeding 3 days are associated with increased morbidity in patients undergoing surgery for uncomplicated adhesive small bowel obstruction. J Trauma Acute Care Surg. 2014 Jun;76(6):1367–72.
Keenan, Jeffrey E., et al. “Trials of nonoperative management exceeding 3 days are associated with increased morbidity in patients undergoing surgery for uncomplicated adhesive small bowel obstruction.J Trauma Acute Care Surg, vol. 76, no. 6, June 2014, pp. 1367–72. Pubmed, doi:10.1097/TA.0000000000000246.
Keenan JE, Turley RS, McCoy CC, Migaly J, Shapiro ML, Scarborough JE. Trials of nonoperative management exceeding 3 days are associated with increased morbidity in patients undergoing surgery for uncomplicated adhesive small bowel obstruction. J Trauma Acute Care Surg. 2014 Jun;76(6):1367–1372.

Published In

J Trauma Acute Care Surg

DOI

EISSN

2163-0763

Publication Date

June 2014

Volume

76

Issue

6

Start / End Page

1367 / 1372

Location

United States

Related Subject Headings

  • Tissue Adhesions
  • Time Factors
  • Retrospective Studies
  • Preoperative Care
  • Postoperative Complications
  • Morbidity
  • Male
  • Length of Stay
  • Intestine, Small
  • Intestinal Obstruction