Document Detail


Impact of gastrografin in clinical practice in the management of adhesive small bowel obstruction.
MedLine Citation:
PMID:  21251420     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Gastrografin (GG) has been shown to accelerate the resolution of adhesive small bowel obstruction (ASBO) and decrease length of stay (LOS) in hospital. Consequently, we instituted a protocol recommending the routine use of GG in patients with ASBO. This study reviews patient outcomes after protocol implementation.
METHODS: We conducted a retrospective review of all patients with ASBO from January 1997 to December 2007. Data were categorized by admission date and use of GG. The outcomes reviewed were protocol uptake, median LOS in hospital and operative rate. Results were analyzed using the Mann-Whitney U test and the 2-tailed Fisher exact test.
RESULTS: There were 710 patients with ASBO overall. Sixteen of 376 (4.3%) patients received GG before institution of the protocol (period 1), whereas 195 of 334 (58.4%) received GG thereafter (period 2). In period 2, use of GG was limited to between 58% and 69% of all potentially eligible patients per year. Fifty-seven of 710 (8%) patients required surgery. In period 1, there were no significant differences in median LOS in hospital (p=0.29) and operative rate (p=0.65) between patients who received GG and those who were managed without GG. In period 2, patients receiving GG had a greater median LOS in hospital (3 [range 2-5] v. 2 [range 1-5] d, p=0.048) but significantly lower operative rates (5.1% v. 12.9%, p=0.018). Overall, the median LOS decreased over time (period 1: 4 [2-7] d v. period 2: 2 [1-5] d, p=0.010). The operative rate did not vary substantially between periods (7.7% v. 8.4%, p=0.42).
CONCLUSION: The introduction of a protocol has increased the proportion of eligible patients receiving GG. However, protocol nonadherence and factors other than GG usage have influenced LOS in hospital and operative rates. Demonstrated benefits from previously published clinical trials have thus not been replicated within our setting.
Authors:
Sanket Srinivasa; Nainoor Thakore; Saleh Abbas; Maryam Mahmood; Arman Adam Kahokehr; Andrew G Hill
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Canadian journal of surgery. Journal canadien de chirurgie     Volume:  54     ISSN:  1488-2310     ISO Abbreviation:  Can J Surg     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-03-29     Completed Date:  2011-06-07     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  0372715     Medline TA:  Can J Surg     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  123-7     Citation Subset:  IM    
Copyright Information:
© 2011 Canadian Medical Association
Affiliation:
Department of Surgery, South Auckland Clinical School, University of Auckland, Auckland, New Zealand.
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MeSH Terms
Descriptor/Qualifier:
Clinical Protocols
Contrast Media / therapeutic use*
Diatrizoate Meglumine / therapeutic use*
Female
Humans
Intestinal Obstruction / pathology,  surgery,  therapy*
Length of Stay
Male
Middle Aged
Retrospective Studies
Tissue Adhesions
Chemical
Reg. No./Substance:
0/Contrast Media; 131-49-7/Diatrizoate Meglumine
Comments/Corrections

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