Small bowel obstruction managed without hospital admission: A safe way to reduce both cost and time in the hospital?

Mahony, Cillian; Traynor, Michael D.; Knight, Ariel W.; Hughes, James L.; Hernandez, Matthew C.; Finnesgard, Eric J.; Musa, Juna; Selby, Sasha; Rivera, Mariela; Kim, Brian D.; Heller, Stephanie F.; Zielinski, Martin D.

doi:10.1016/j.surg.2021.10.041

Cited by 4 publications

(4 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, progressive bowel dilation accompanied by compromised venous reflux increases intramural tension, which causes mural edema, secondary intestinal absorptive dysfunction and the loss of mucosal integrity (both functionally and physically)[ 22 , 30 ]. Similarly, as a potential effect on decreasing mural edema, the use of gastrografin challenge has been identified as the standardized management for SBO[ 31 , 32 ]. Moreover, in this study, the LMR was much lower in the high PC group, which may be due to the immune system becoming weakened as a result of the underlying malnutrition, as well as an excessive compensatory anti-inflammatory response[ 33 - 37 ].…”

Section: Discussionmentioning

confidence: 99%

Comprehensively evaluate the short outcome of small bowel obstruction: A novel medical-economic score system

Xu¹,

Zhong²,

Cai³

et al. 2023

World J Gastroenterol

View full text Add to dashboard Cite

BACKGROUND Small bowel obstruction (SBO) still imposes a substantial burden on the health care system. Traditional evaluation systems for SBO outcomes only focus on a single element. The comprehensive evaluation of outcomes for patients with SBO remains poorly studied. Early intensive clinical care would effectively improve the short-term outcomes for SBO, however, the full spectrum of the potential risk status regarding the high complication-cost burden is undetermined. AIM We aim to construct a novel system for the evaluation of SBO outcomes and the identification of potential risk status. METHODS Patients who were diagnosed with SBO were enrolled and stratified into the simple SBO (SiBO) group and the strangulated SBO (StBO) group. A principal component (PC) analysis was applied for data simplification and the extraction of patient characteristics, followed by separation of the high PC score group and the low PC score group. We identified independent risk status on admission via a binary logistic regression and then constructed predictive models for worsened management outcomes. Receiver operating characteristic curves were drawn, and the areas under the curve (AUCs) were calculated to assess the effectiveness of the predictive models. RESULTS Of the 281 patients, 45 patients (16.0%) were found to have StBO, whereas 236 patients (84.0%) had SiBO. Regarding standardized length of stay (LOS), total hospital cost and the presence of severe adverse events (SAEs), a novel principal component was extracted (PC score = 0.429 × LOS + 0.444 × total hospital cost + 0.291 × SAE). In the multivariate analysis, risk statuses related to poor results for SiBO patients, including a low lymphocyte to monocyte ratio (OR = 0.656), radiological features of a lack of small bowel feces signs (OR = 0.316) and mural thickening (OR = 1.338), were identified as risk factors. For the StBO group, higher BUN levels (OR = 1.478) and lower lymphocytes levels (OR = 0.071) were observed. The AUCs of the predictive models for poor outcomes were 0.715 (95%CI: 0.635-0.795) and 0.874 (95%CI: 0.762-0.986) for SiBO and StBO stratification, respectively. CONCLUSION The novel PC indicator provided a comprehensive scoring system for evaluating SBO outcomes on the foundation of complication-cost burden. According to the relative risk factors, early tailored intervention would improve the short-term outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Comprehensively evaluate the short outcome of small bowel obstruction: A novel medical-economic score system

Xu¹,

Zhong²,

Cai³

et al. 2023

World J Gastroenterol

View full text Add to dashboard Cite

show abstract

“…Practice management guidelines incorporating the GG challenge have even been shown to reduce hospitalization rates when performed in the emergency department. While care must be taken to ensure the appropriateness of the candidates, there was a 49% reduction in costs with a median ED length of stay (LOS) of 23.6 hours 6 …”

Section: Deciding If and When To Operatementioning

confidence: 99%

“…While care must be taken to ensure the appropriateness of the candidates, there was a 49% reduction in costs with a median ED length of stay (LOS) of 23.6 hours. 6 It must be noted that there are differing opinions regarding the use of the GG challenge. There have been 11 oral contrast randomized controlled trials (RCTs) in the setting of SBO over the past 30 years.…”

mentioning

confidence: 99%

Surgical management of small bowel obstruction: What you need to know

Quach,

Zielinski

2023

J Trauma Acute Care Surg

Self Cite

View full text Add to dashboard Cite

Small bowel obstruction management has undergone a paradigm shift over the past decade. Surgical dictum had taught us to never let the “sun rise or set on a small bowel obstruction.” We have subsequently learned that a nuanced approach to this disease using practice management guidelines to drive our clinical decision making must be taken. In this review, we will delve into the process of deciding who needs an urgent/emergent operation versus observing a patient on the ward. We will also discuss how long to wait until an exploration should be performed for those patients initially undergoing non-operative management, and, once in the operating room, the fundamental techniques and newer approaches which should be in surgeon’s armamentarium. Lastly, we will highlight the approach to less common causes of small bowel obstruction including malignant bowel obstruction, virgin abdomens, and Crohn’s disease.

show abstract

“…Gastrographin is a water-soluble contrast media formed by diatrizoate meglumine and diatrizoate sodium which is used as an alternative to barium sulfate in patients who are at higher risk for bowel obstruction or perforation. Its use seems to be safe both orally and by enema solution administration in infants but no evidence is available about its use during pregnancy [ 49 , 50 ].…”

Section: Classification Of Contrast Agentsmentioning

confidence: 99%

Contrast Agents during Pregnancy: Pros and Cons When Really Needed

Perelli

Turrini

Giorgi

et al. 2022

IJERPH

View full text Add to dashboard Cite

Many clinical conditions require radiological diagnostic exams based on the emission of different kinds of energy and the use of contrast agents, such as computerized tomography (CT), positron emission tomography (PET), magnetic resonance (MR), ultrasound (US), and X-ray imaging. Pregnant patients who should be submitted for diagnostic examinations with contrast agents represent a group of patients with whom it is necessary to consider both maternal and fetal effects. Radiological examinations use different types of contrast media, the most used and studied are represented by iodinate contrast agents, gadolinium, fluorodeoxyglucose, gastrographin, bariumsulfate, and nanobubbles used in contrast-enhanced ultrasound (CEUS). The present paper reports the available data about each contrast agent and its effect related to the mother and fetus. This review aims to clarify the clinical practices to follow in cases where a radiodiagnostic examination with a contrast medium is indicated to be performed on a pregnant patient.

show abstract

Small bowel obstruction managed without hospital admission: A safe way to reduce both cost and time in the hospital?

Cited by 4 publications

References 29 publications

Comprehensively evaluate the short outcome of small bowel obstruction: A novel medical-economic score system

Comprehensively evaluate the short outcome of small bowel obstruction: A novel medical-economic score system

Surgical management of small bowel obstruction: What you need to know

Contrast Agents during Pregnancy: Pros and Cons When Really Needed

Contact Info

Product

Resources

About