Management and outcomes of small bowel obstruction in older adult patients: a prospective cohort study

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.Contexte : Le but de cette recherche était d'analyser la morbidité, la mortalité et le taux de récurrence de l'occlusion intestinale associés au traitement de l'occlusion intestinale grêle (OIG) chez des adultes âgés.Méthodes : Nous avons inscrit de manière prospective tous les patients de 70 ans ou plus présentant une OIG qui ont été admis dans un établissement de soins tertiaires entre le 1er juillet 2011 et le 30 septembre 2012. Nous avons recueilli les données concernant les tableaux cliniques, les épreuves diagnostiques, les traitements et leurs résultats. Résultats :Parmi les 104 patients admis pour OIG, 49 % ont été traités non chirurgicalement et 51 % ont subi une intervention chirurgicale. Les patients soumis à la chirurgie ont présenté davantage de complications (64 % c. 27 %, p = 0,002) et ont séjourné plus longtemps à l'hôpital (10 j. c. 3 j., p < 0,001) comparativement aux patients qui n'ont pas été opérés. La prise en charge non chirurgicale a été associée à un taux élevé de récurrences de l'OIG : 31 % après un suivi médian de 17 mois. Parmi les patients opérés, 60 % ont subi une chirurgie immédiate et 40 % ont subi leur chirurgie après une tentative de prise en charge non chirurgicale. Les patients chez qui la prise en charge non chirurgicale a échoué ont subi leur chirurgie après une période médiane de 2 jours et 89 % en l'espace de 5 jours. Le taux de résection intestinale a été élevé (29 %) chez ceux dont la chirurgie a été retardée. La chirurgie après une intervention non chirurgicale infructueuse a été associée à un taux d...

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

“…Absolute indications for surgery were clinical signs of strangulation, peritonitis, worsening leucocytosis, metabolic acidosis, radiological evidence of bowel ischaemia and failure to progress. Contrary to existing international guidelines suggesting a trial of non‐operative management for up to 3 days, recently published data show that intervention in the first 24–48 h is associated with improved survival . In our study, we have observed a decrease in a number of patients operated 5 or more days after presentation and this may partly account for the demonstrated mortality benefit.…”

“…This is in keeping with the reported rate of 24–51% in recent studies . Our population included patients with repeated presentation of SBO and over 40% of our patients were over 70 years old – both factors are associated with increase in surgical management . The observed rate of bowel resection in our study is high, but comparable with previously reported .…”

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Intestinal Obstruction Secondary to Postoperative Peritoneal Adhesions: the Tolerability of the Conservative Treatment

“…Postoperative peritoneal adhesion syndrome represents the main cause for the intestinal obstruction in adults 1,2 .…”

Early Recovery after Small Bowel Surgery

“…8 Postoperative care has evolved significantly over the past few decades with emphasis on a safe, stress free and early recovery of the patients. 9 Conventional postoperative care emphasized resting the gastrointestinal tract until full recovery of function occurs. Prolonged preoperative fasting, use of long acting sedatives, anesthetic agents and opiates, I/V fluids in excess, extended use of drains, nasogastric tubes, urinary catheters, and prolonged nil per oral status all contributed to delayed convalescence after surgery.…”