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10.02.2020 | Original Article

Re-examining “Never Letting the Sun Rise or Set on a Bowel Obstruction” in the Era of Acute Care Surgery

Zeitschrift:
Journal of Gastrointestinal Surgery
Autoren:
Adrian Diaz, Kevin B. Ricci, Amy P. Rushing, Angela M. Ingraham, Vijaya T. Daniel, Anghela Z. Paredes, Holly E. Baselice, Wendelyn M. Oslock, Victor Heh, Scott A. Strassels, Heena P. Santry
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11605-019-04496-3) contains supplementary material, which is available to authorized users.
Presented at the 33rd Annual Meeting of Eastern Association for the Surgery of Trauma, January 18, 2019, in Austin, TX

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Abstract

Background

Small bowel obstruction (SBO) no longer mandates urgent surgical evaluation raising the question of the role of operating room (OR) access on SBO outcomes.

Methods

Data from our 2015 survey on emergency general surgery (EGS) practices, including queries on OR availability and surgical staffing, were anonymously linked to adult SBO patient data from 17 Statewide Inpatient Databases (SIDs). Univariate and multivariable associations between OR access and timing of operation, complications, length of stay (LOS), and in-hospital mortality were measured.

Results

Of 32,422 SBO patients, 83% were treated non-operatively. Operative patients were older (median 66 vs 65 years), had more comorbidities (53% vs 46% with ≥ 3), and experienced more systemic complications (36% vs 23%), higher mortality (2.8% vs 1.4%), and longer LOS (median 10 vs 4 days). Patients had lower odds of operation if treated at hospitals lacking processes to tier urgent cases (aOR 0.90, 95% CI [0.83–0.99]) and defer elective cases (aOR 0.87 [0.80–0.94]). Patients had higher odds of operation if treated at hospitals with surgeons sometimes (aOR 1.14 [1.04–1.26]) or rarely/never (aOR 1.16 [1.06–1.26]) covering EGS at more than one location compared to always. Odds of systemic complication (OR 2.0 [1.6–2.4]), operative complication (OR 1.5 [1.2–1.8]), and mortality were increased for very late versus early operation (OR 2.6 [1.7–4.0]).

Conclusions

Although few patients with SBO require emergency surgery, we identified EGS structures and processes that are important for providing timely and appropriate intervention for patients whose SBO remains unresolved and requires surgery.

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