Annals of surgery · 2013
Early operation is associated with a survival benefit for patients with adhesive bowel obstruction.
Оценочное исследованиеСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Teixeira Pedro G, Karamanos Efstathios, Talving Peep, Inaba Kenji, Lam Lydia, Demetriades Demetrios
Аннотация
OBJECTIVE: To evaluate the effect of surgical delay on the outcomes of patients with adhesive small bowel obstruction (ASBO).
BACKGROUND: It is generally accepted that patients with uncomplicated ASBO failing nonoperative management should be operated on within 5 days. However, the optimal time of operation within this 5-day period is unknown.
METHODS: Patients requiring surgery for ASBO were identified from the National Surgical Quality Improvement Program database. Linear regression was performed to evaluate the impact of incremental surgical delay in mortality and complications. The study population was stratified by time to intervention (24-hour intervals), and logistic regression was performed to adjust for premorbid conditions and presentation physiology. The outcomes included 30-day mortality and infectious complications.
RESULTS: A total of 4163 patients underwent laparotomy for ASBO. Mortality and complications increased significantly with operative delay. Delay of 24 hours or more was associated with significantly higher mortality: 6.5% vs 3.0%; adjusted odds ratio (AOR) [95% confidence interval (CI), 1.58 (1.12-2.24)]; P = 0.009. The delayed operation group (≥24 hours) also had significantly higher rates of surgical site infections [12.9% vs 10.0%; AOR (95% CI), 1.33 (1.08-1.62); P = 0.007], pneumonia (7.9% vs 5.2%; AOR (95% CI), 1.36 (1.04-1.78); P = 0.025], sepsis [7.6% vs 5.1%; AOR (95% CI), 1.45 (1.10-1.90); P = 0.007], and septic shock [6.2% vs 3.5%; AOR (95% CI), 1.47 (1.07-2.02); P = 0.018]. Early operation was associated with significantly shorter hospital stay [8.4 ± 8.3 vs 14.4±13.5 days; adjusted mean difference (95% CI), -5.2 (-5.9 to -4.4); P<0.001].
CONCLUSIONS: Early operative intervention for patients with ASBO is associated with a significant survival benefit, lower incidence of local and systemic complications, and shorter hospitalization.
BACKGROUND: It is generally accepted that patients with uncomplicated ASBO failing nonoperative management should be operated on within 5 days. However, the optimal time of operation within this 5-day period is unknown.
METHODS: Patients requiring surgery for ASBO were identified from the National Surgical Quality Improvement Program database. Linear regression was performed to evaluate the impact of incremental surgical delay in mortality and complications. The study population was stratified by time to intervention (24-hour intervals), and logistic regression was performed to adjust for premorbid conditions and presentation physiology. The outcomes included 30-day mortality and infectious complications.
RESULTS: A total of 4163 patients underwent laparotomy for ASBO. Mortality and complications increased significantly with operative delay. Delay of 24 hours or more was associated with significantly higher mortality: 6.5% vs 3.0%; adjusted odds ratio (AOR) [95% confidence interval (CI), 1.58 (1.12-2.24)]; P = 0.009. The delayed operation group (≥24 hours) also had significantly higher rates of surgical site infections [12.9% vs 10.0%; AOR (95% CI), 1.33 (1.08-1.62); P = 0.007], pneumonia (7.9% vs 5.2%; AOR (95% CI), 1.36 (1.04-1.78); P = 0.025], sepsis [7.6% vs 5.1%; AOR (95% CI), 1.45 (1.10-1.90); P = 0.007], and septic shock [6.2% vs 3.5%; AOR (95% CI), 1.47 (1.07-2.02); P = 0.018]. Early operation was associated with significantly shorter hospital stay [8.4 ± 8.3 vs 14.4±13.5 days; adjusted mean difference (95% CI), -5.2 (-5.9 to -4.4); P<0.001].
CONCLUSIONS: Early operative intervention for patients with ASBO is associated with a significant survival benefit, lower incidence of local and systemic complications, and shorter hospitalization.