European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026
Small bowel obstruction in older adults: similar nonoperative success but worse outcomes across management strategies - insights from the ESTES SnapSBO study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Bunino Francesca Margherita, Cimino Matteo Maria, Martinez Casas Isidro, Bellio Gabriele, Porta Matteo, Cayre Luigi, Mohseni Shahin, Kaplan Lewis J, Lee Matthew J, Bass Gary Alan, Kurihara Hayato, ESTES SnapSBO Group
Аннотация
BACKGROUND: Small bowel obstruction (SBO) is a common surgical emergency. It remains unclear whether adverse outcomes in older patients reflect impaired obstruction resolution, differences in disease phenotype, or reduced physiologic tolerance.
METHODS: We performed a prespecified age-stratified analysis of the multicenter SnapSBO cohort, which consecutively enrolled adults with radiologically-confirmed mechanical SBO, stratified as younger (< 65 years) or older (≥ 65 years). Presentation, etiology, management, and outcomes were compared using risk differences and odds ratios. Exploratory analyses evaluated patients aged 65-79 years and ≥ 80 years.
RESULTS: Among 1,731 patients, 729 (42.1%) were aged ≥ 65 years. Older adults had more non-adhesive etiologies, including neoplastic and inflammatory obstruction, and more imaging features of severe disease. They were less likely to undergo a trial of nonoperative management (67.9% vs. 72.7%; absolute risk difference, - 4.8%; P = 0.037). However, among those managed nonoperatively, resolution rates were similar (68.8% vs. 69.5%). Despite this, older adults experienced higher rates of complications (16.7% vs. 6.7%), aspiration pneumonia (3.8% vs. 1.0%), and in-hospital mortality (6.9% vs. 3.6%). Those aged ≥ 80 years showed similar management but substantially higher mortality and complications.
CONCLUSIONS: Older adults achieved similar nonoperative resolution despite worse outcomes, suggesting chronological age incompletely captures treatment-relevant risk. These outcomes may reflect disease phenotype, frailty, physiologic vulnerability, or response to complications. Decision-making should integrate etiology, imaging-defined severity, frailty, and physiologic vulnerability rather than age alone.
METHODS: We performed a prespecified age-stratified analysis of the multicenter SnapSBO cohort, which consecutively enrolled adults with radiologically-confirmed mechanical SBO, stratified as younger (< 65 years) or older (≥ 65 years). Presentation, etiology, management, and outcomes were compared using risk differences and odds ratios. Exploratory analyses evaluated patients aged 65-79 years and ≥ 80 years.
RESULTS: Among 1,731 patients, 729 (42.1%) were aged ≥ 65 years. Older adults had more non-adhesive etiologies, including neoplastic and inflammatory obstruction, and more imaging features of severe disease. They were less likely to undergo a trial of nonoperative management (67.9% vs. 72.7%; absolute risk difference, - 4.8%; P = 0.037). However, among those managed nonoperatively, resolution rates were similar (68.8% vs. 69.5%). Despite this, older adults experienced higher rates of complications (16.7% vs. 6.7%), aspiration pneumonia (3.8% vs. 1.0%), and in-hospital mortality (6.9% vs. 3.6%). Those aged ≥ 80 years showed similar management but substantially higher mortality and complications.
CONCLUSIONS: Older adults achieved similar nonoperative resolution despite worse outcomes, suggesting chronological age incompletely captures treatment-relevant risk. These outcomes may reflect disease phenotype, frailty, physiologic vulnerability, or response to complications. Decision-making should integrate etiology, imaging-defined severity, frailty, and physiologic vulnerability rather than age alone.