Jeremy E Springer1, Jonathan G Bailey1, Philip J B Davis1, Paul M Johnson2. 1. The Division of General Surgery, Dalhousie University, Halifax, NS. 2. The Division of General Surgery and the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS.
Abstract
BACKGROUND: The purpose of this research was to examine the morbidity, mortality and rate of recurrent bowel obstruction associated with the treatment of small bowel obstruction (SBO) in older adults. METHODS: We prospectively enrolled all patients 70 years or older with an SBO who were admitted to a tertiary care teaching centre between Jul. 1, 2011, and Sept. 30, 2012. Data regarding presentation, investigations, treatment and outcomes were collected. RESULTS: Of the 104 patients admitted with an SBO, 49% were managed nonoperatively and 51% underwent surgery. Patients who underwent surgery experienced more complications (64% v. 27%, p = 0.002) and stayed in hospital longer (10 v. 3 d, p < 0.001) than patients managed nonoperatively. Nonoperative management was associated with a high rate of recurrent SBO: 31% after a median follow-up of 17 months. Of the patients managed operatively, 60% underwent immediate surgery and 40% underwent surgery after attempted nonoperative management. Patients in whom nonoperative management failed underwent surgery after a median of 2 days, and 89% underwent surgery within 5 days. The rate of bowel resection was high (29%) among those who underwent delayed surgery. Surgery after failed nonoperative management was associated with a mortality of 14% versus 3% for those who underwent immediate surgery; however, this difference was not significant. CONCLUSION: These data suggest that some elderly patients with SBO may be waiting too long for surgery.
BACKGROUND: The purpose of this research was to examine the morbidity, mortality and rate of recurrent bowel obstruction associated with the treatment of small bowel obstruction (SBO) in older adults. METHODS: We prospectively enrolled all patients 70 years or older with an SBO who were admitted to a tertiary care teaching centre between Jul. 1, 2011, and Sept. 30, 2012. Data regarding presentation, investigations, treatment and outcomes were collected. RESULTS: Of the 104 patients admitted with an SBO, 49% were managed nonoperatively and 51% underwent surgery. Patients who underwent surgery experienced more complications (64% v. 27%, p = 0.002) and stayed in hospital longer (10 v. 3 d, p < 0.001) than patients managed nonoperatively. Nonoperative management was associated with a high rate of recurrent SBO: 31% after a median follow-up of 17 months. Of the patients managed operatively, 60% underwent immediate surgery and 40% underwent surgery after attempted nonoperative management. Patients in whom nonoperative management failed underwent surgery after a median of 2 days, and 89% underwent surgery within 5 days. The rate of bowel resection was high (29%) among those who underwent delayed surgery. Surgery after failed nonoperative management was associated with a mortality of 14% versus 3% for those who underwent immediate surgery; however, this difference was not significant. CONCLUSION: These data suggest that some elderly patients with SBO may be waiting too long for surgery.
Authors: Lucas W Thornblade; Francys C Verdial; Matthew A Bartek; David R Flum; Giana H Davidson Journal: J Gastrointest Surg Date: 2019-02-20 Impact factor: 3.452
Authors: C J van Beekum; B Stoffels; M von Websky; J Dohmen; C J J Paul; J C Kalff; T O Vilz Journal: Med Klin Intensivmed Notfmed Date: 2019-12-02 Impact factor: 0.840
Authors: Andrew J Medvecz; Bradley M Dennis; Li Wang; Christopher J Lindsell; Oscar D Guillamondegui Journal: J Am Coll Surg Date: 2020-01-17 Impact factor: 6.113
Authors: D H Kim; H Wit; M Thurston; M Long; G F Maskell; M J Strugnell; D Shetty; I M Smith; N P Hollings Journal: Br J Radiol Date: 2021-04-27 Impact factor: 3.039
Authors: Virginie Gaget; Maria C Inacio; David R Tivey; Robert N Jorissen; Wendy Babidge; Renuka Visvanathan; Guy J Maddern Journal: BMC Geriatr Date: 2022-02-04 Impact factor: 3.921
Authors: Ekin Ozturk; Marianne van Iersel; Martijn Mwj Stommel; Yvonne Schoon; Richard Rpg Ten Broek; Harry van Goor Journal: World J Emerg Surg Date: 2018-10-20 Impact factor: 5.469