Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction

Musiienko, Anton M.; Shakerian, Rose; Gorelik, Alexandra; Thomson, Benjamin; Skandarajah, Anita

doi:10.1111/ans.13238

Cited by 23 publications

(10 citation statements)

References 27 publications

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“…While increased patient load compared to earlier years might be expected, this has not been the case in some ASU cohorts . For those ASUs that did experience greater throughput, equivalent or superior results for the three key outcomes of time to theatre, daytime operating and length of stay were maintained by most but not all sites …”

Section: Discussionmentioning

confidence: 97%

Acute surgical unit improves outcomes in appendicectomy

Kinnear

Bramwell²,

Frazzetto

et al. 2019

ANZ Journal of Surgery

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Background: Few large Australian studies have explored the impact of acute surgical unit (ASU) model in appendicitis.Methods: An ASU model commenced practice at our institution on 1 August 2012. In this retrospective cohort study, patients undergoing appendicectomy 2.5 years before (Traditional group) or after (ASU group) this date were compared. Primary outcomes were median length of stay, median time from emergency department referral to theatre start and proportion of cases performed in-hours. Secondary outcomes were rates of complications, open appendicectomy, consultant scrubbed for procedure, intensive care unit admission and re-presentation to emergency department within 30 days. Results: After removing those with incomplete data, 1214 patients were enrolled; 465 in the Traditional group and 749 in the ASU group. There were no significant baseline differences between groups. Compared with the Traditional group, ASU patients had similar length of stay (1.81 versus 1.81 days; P = 0.54) and time to theatre (0.59 versus 0.56 days; P = 0.14), but a greater proportion of in-hours operation (72% versus 79%; P = 0.014). The ASU group also experienced fewer complications (9% versus 6%; P = 0.031), fewer primary open (4% versus 1%; P < 0.0001) or conversion-to-open appendicectomies (6% versus 2%; P < 0.0005) and had superior rates of consultant scrubbed in theatre (21% versus 56%; P < 0.00001). Rates of intensive care unit admission (1% versus 1%; P = 0.72) and re-presentation were unchanged (5% versus 5%; P = 0.46). Conclusion: In our institution, the introduction of an ASU model was associated with more in-hours operations and safer care for patients undergoing appendicectomy.

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Section: Discussionmentioning

confidence: 97%

Acute surgical unit improves outcomes in appendicectomy

Kinnear

Bramwell²,

Frazzetto

et al. 2019

ANZ Journal of Surgery

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“…However, in previous studies, 20-30% [1,24] to 45% [6] patients with ASBO required surgery. A larger portion of laparoscopic surgery and active adoption of anti-adhesive barriers may have affected the results.…”

Section: Discussionmentioning

confidence: 87%

Feasibility of the Gastrografin Challenge for Adhesive Small Bowel Obstruction

et al. 2021

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Adhesive small bowel obstruction (ASBO) is one of the most important presentations in gastrointestinal emergencies [1][2][3], with previous abdominal surgery being a major etiology [4]. Although the use of anti-adhesive barriers and an increase in the use of laparoscopic surgery have decreased adhesionrelated complications [5,6], a recent epidemiologic study has reported that 1 in 4 patients who undergo open or laparoscopic abdominal surgery is readmitted for causes related to adhesions [6]. Furthermore, ASBO has a high recurrence rate of up to 20% within 5 years, either with conservative management

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“…Несмотря на столь существенный срок, научный поиск в данном направлении далек от своего завершения, о чем свидетельствуют высокая частота спаечной болезни, отсутствие унифицированного подхода к ее лечению и эффективных схем профилактики рецидива заболевания. Наиболее серьезной формой этого заболевания, безусловно, является острая спаечная кишечная непроходимость (ОСКН), основным методом лечения которой остается срочное хирургическое вмешательство [1,2].…”

Section: акт уальностьunclassified

The Point-Rating Scale for Determining Treatment Tactics in Patients With Adhesive Small Bowel Obstruction

Сигуа

Земляной

Филенко

et al. 2021

Neotložnaâ med. pomoŝʹ

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Relevance. The most practiced method of treating patients with acute intestinal obstruction - urgent surgical intervention - does not guarantee remission, contributing to the progression of morphological changes in the abdominal cavity. From this perspective, a shift in emphasis towards the planned surgical treatment of patients with adhesive disease with the use of the existing anti-adhesive methods after conservative resolution of the intestinal passage disorders looks like a promising direction.Aim of the study. Improving the results of patients with acute adhesive intestinal obstruction treatment by developing a point-rating scale that allows to highlight groups of patients who are prone to conservative resolution of intestinal passage disorders episode, and, thereby, reduces the proportion of urgent interventions.Material and methods. The analysis of the 125 patients treatment results (retrospective group) admitted with symptoms of acute adhesive intestinal obstruction was carried out. On this basis, the point-rating scale was developed including a number of factors that have certain value in terms of predicting the probability of conservative therapy success. Subsequently the developed scale was applied in 170 patients (prospective group) as part of treatment tactics implementation aimed at maximally conservative resolution of adhesive intestinal obstruction without negative effect on the immediate results of patients operated in later periods.Results. The developed point-rating scale made it possible to reduce the frequency of urgent interventions among patients with signs of acute adhesive intestinal obstruction (from 79.2% to 57.6%) due to longer conservative measures — 18.1±17.2 and 11,2±8.7 hours in prospective and retrospective groups, respectively). There was no negative impact on the frequency of resection interventions (12.2 and 16.1% in the prospective and retrospective groups) as well as postoperative complications and overall mortality.Conclusions. The developed point-assessment scale made it possible to stratify patients in accordance with the probability of conservative therapy success and to justify its continuation for more than 12 hours in low-risk patients. The obtained results allow us to recommend the proposed scale for use in clinical practice.

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Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction

Cited by 23 publications

References 27 publications

Acute surgical unit improves outcomes in appendicectomy

Acute surgical unit improves outcomes in appendicectomy

Feasibility of the Gastrografin Challenge for Adhesive Small Bowel Obstruction

The Point-Rating Scale for Determining Treatment Tactics in Patients With Adhesive Small Bowel Obstruction

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