Document Detail


Prevalence and risk factors of mortality and morbidity after operation for adhesive postoperative small bowel obstruction.
MedLine Citation:
PMID:  18367136     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Many factors are believed to influence the mortality and morbidity after operations for adhesive small bowel obstruction (SBO). METHODS: In a multicenter prospective cohort of 286 patients operated on for adhesive postoperative SBO, we studied the in-hospital and 30-day postdischarge mortality (early mortality) and morbidity as well as long-term mortality using univariate and multivariate analysis. RESULTS: In the present cohort, with a median follow-up of 41 months and 9% patients lost to follow-up at the end of the study, the prevalence of early postoperative mortality was 3%. All deceased patients were over 75 years old with an American Society of Anesthesiologists (ASA) class >/=III. The prevalence of long-term mortality was 7% with the following independent risk factors: age >75 years old (hazards ratio [HR] 6.6 [95% confidence interval [CI], 2.4-18.1]), medical complications (HR 7.4 [CI, 2.2-24.3]), and a mixed mechanism of obstruction (HR 4.5 [CI, 1.5-13.7]). Prevalence of medical and surgical morbidity was 8% and 6%, respectively. Independent risk factors for medical complications were ASA class >/=III (odds ratio [OR] 16.8 [CI, 2.1-133.1]) and bands (OR 14.1 [CI, 1.8-111.5]) and for the surgical complications the number of obstructive structures >/=10 (OR 8.3 [CI, 1.6-19.7]), a nonresected intestinal wall injury (OR 5.3 [CI, 1.5-18.3]), and intestinal necrosis (OR 5.6 [CI, 1.6-19.7]). Otherwise, 3 patients with "apparent" reversible ischemia developed a postoperative intestinal necrosis followed by 2 reoperations and 1 death. CONCLUSION: The early postoperative mortality is strongly linked with the age and the ASA class and the long-term mortality with postoperative complications. More frequent bowel resections might be suggested for patients featuring a number of obstructive structures >/=10 and an intestinal wall injury, especially when associated with a reversible intestinal ischemia.
Authors:
Jean-Jacques Duron; Sophie Tezenas du Montcel; Anne Berger; Fabrice Muscari; Henri Hennet; Michel Veyrieres; Jean Marie Hay;
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  American journal of surgery     Volume:  195     ISSN:  1879-1883     ISO Abbreviation:  Am. J. Surg.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-02     Completed Date:  2008-08-05     Revised Date:  2009-05-20    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  726-34     Citation Subset:  AIM; IM    
Affiliation:
Department of General Surgery University Hospital La Pitié, Paris, France. jean-jacques.duron@psl.aphp.fr
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Aged
Female
Humans
Intestinal Obstruction / etiology,  mortality,  surgery*
Intestine, Small / surgery*
Male
Middle Aged
Peritoneal Diseases / surgery
Postoperative Complications*
Risk Factors
Survival Rate
Tissue Adhesions / complications,  surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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