Annals of surgery · 2025
Recurrence Following Operative Versus Nonoperative Management of Adhesive Small Bowel Obstruction in Children: A Multicenter Prospective Observational Study.
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеСравнительное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Patwardhan Utsav M, Ignacio Romeo C, Pickett-Nairne Kaci, Russell Katie W, Lee Justin, Padilla Ben, Melhado Caroline, Kelley-Quon Lorraine I, Rothstein David H, Thangarajah Hariharan, Ibarra-Meraz Ana, Barq Rabab M, Larsen Kezlyn E, Fowler Kathryn L, Hunteman Zebediah, Valencia-Bradd Maria, Lofberg Katrine, Jensen Aaron, Pandya Samir, Acker Shannon N, Western Pediatric Surgery Research Consortium
Аннотация
OBJECTIVES: Data on the incidence of recurrent adhesive small bowel obstruction (ASBO) following index admission for ASBO in children are limited. We sought to determine if operative management was associated with a lower rate of recurrence compared to nonoperative management (NOM).
METHODS: We conducted a prospective observational study of children with ASBO admitted to 9 hospitals from October 2020 to December 2022 who underwent a trial of NOM. Children were followed for a year after admission. The primary outcome was readmission for recurrent ASBO. Adjusted comparisons were made between children successfully managed nonoperatively at the index admission and those who underwent surgery.
RESULTS: Among 136 children, 87 (63.9%) had successful NOM at the index admission. Within 1 year, 20 patients (14.7%; 17/87 NOM group; 3/49 operative group) had recurrent ASBO. On unadjusted analysis, there was a higher risk of recurrent ASBO in the NOM group (19.5 vs 6.1%, P =0.04). However, after adjusting for age (HR: 0.35, CI: 0.10-1.23), there was no significant difference. Among patients with recurrent ASBO, 7/20 (35%) underwent an urgent or emergent operation at readmission; this rate was similar between initial management groups.
CONCLUSIONS: Although the rate of recurrent ASBO in children is nearly 15% within 1 year, this rate does not differ based on the initial management strategy. Among children with recurrent ASBO, one-third underwent an urgent or emergent operation at readmission. NOM appears to be as effective in preventing recurrent ASBO as surgery.
METHODS: We conducted a prospective observational study of children with ASBO admitted to 9 hospitals from October 2020 to December 2022 who underwent a trial of NOM. Children were followed for a year after admission. The primary outcome was readmission for recurrent ASBO. Adjusted comparisons were made between children successfully managed nonoperatively at the index admission and those who underwent surgery.
RESULTS: Among 136 children, 87 (63.9%) had successful NOM at the index admission. Within 1 year, 20 patients (14.7%; 17/87 NOM group; 3/49 operative group) had recurrent ASBO. On unadjusted analysis, there was a higher risk of recurrent ASBO in the NOM group (19.5 vs 6.1%, P =0.04). However, after adjusting for age (HR: 0.35, CI: 0.10-1.23), there was no significant difference. Among patients with recurrent ASBO, 7/20 (35%) underwent an urgent or emergent operation at readmission; this rate was similar between initial management groups.
CONCLUSIONS: Although the rate of recurrent ASBO in children is nearly 15% within 1 year, this rate does not differ based on the initial management strategy. Among children with recurrent ASBO, one-third underwent an urgent or emergent operation at readmission. NOM appears to be as effective in preventing recurrent ASBO as surgery.