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Re-examining 'Never Letting the Sun Rise or Set on a Bowel Obstruction' in the Era of Acute Care Surgery
- Source :
- J Gastrointest Surg
- Publication Year :
- 2019
-
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 moresystemic 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.
- Subjects :
- Adult
medicine.medical_specialty
030230 surgery
Article
Odds
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Emergency surgery
Intestine, Small
Medicine
Humans
Acute care surgery
Systemic complication
business.industry
General surgery
Gastroenterology
Postoperative complication
Patient data
Length of Stay
medicine.disease
Bowel obstruction
030220 oncology & carcinogenesis
Surgery
Emergencies
business
Intestinal Obstruction
Subjects
Details
- ISSN :
- 18734626
- Volume :
- 25
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
- Accession number :
- edsair.doi.dedup.....a65c8eeb5e15866928bb647bd824e2f7