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Clinical outcome in acute small bowel obstruction after surgical or conservative management.

Meier RP, de Saussure WO, Orci LA, Gutzwiller EM, Morel P, Ris F, Schwenter F - World J Surg (2014)

Bottom Line: Five-year mortality from the date of hospital discharge was not significantly different between the two groups (age- and sex-adjusted HR, 1.1; 95 % CI, 0.6-2.1).Among them, 24 patients (34.8 %) of the surgical group and 35 patients (57.4 %) of the conservative group had recurrent SBO symptoms (odds ratio, 0.4; 95 % CI, 0.2-0.8).The recurrence of SBO symptoms and new hospitalizations were significantly lower after surgical management of SBO compared with conservative treatment.

View Article: PubMed Central - PubMed

Affiliation: Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland, Raphael.Meier@hcuge.ch.

ABSTRACT

Background: Small bowel obstruction (SBO) is characterized by a high rate of recurrence. In the present study, we aimed to compare the outcomes of patients managed either by conservative treatment or surgical operation for an episode of SBO.

Methods: The outcomes of all patients hospitalized at a single center for acute SBO between 2004 and 2007 were assessed. The occurrence of recurrent hospitalization, surgery, SBO symptoms at home, and mortality was determined.

Results: Among 221 patients admitted with SBO, 136 underwent a surgical procedure (surgical group) and 85 were managed conservatively (conservative group). Baseline characteristics were similar between treatment groups. The median follow-up time (interquartile range) was 4.7 (3.7-5.8) years. Nineteen patients (14.0 %) of the surgical group were hospitalized for recurrent SBO versus 25 (29.4 %) of the conservative group [hazard ratio (HR), 0.5; 95 % CI, 0.3-0.9]. The need for a surgical management of a new SBO episode was similar between the two groups, ten patients (7.4 %) in the surgical group and six patients (7.1 %) in the conservative group (HR, 1.1; 95 % CI, 0.4-3.1). Five-year mortality from the date of hospital discharge was not significantly different between the two groups (age- and sex-adjusted HR, 1.1; 95 % CI, 0.6-2.1). A follow-up evaluation was obtained for 130 patients. Among them, 24 patients (34.8 %) of the surgical group and 35 patients (57.4 %) of the conservative group had recurrent SBO symptoms (odds ratio, 0.4; 95 % CI, 0.2-0.8).

Conclusions: The recurrence of SBO symptoms and new hospitalizations were significantly lower after surgical management of SBO compared with conservative treatment.

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Related in: MedlinePlus

Kaplan–Meier estimates of a the hospitalization-free survival, b operation-free survival, c overall survival, and d survival from hospital discharge (i.e., excluding patients who died within 30 days after admission). p values were calculated with the log rank test. Age- and sex-adjusted p values were calculated with multivariate Cox proportional-hazards regression analysis
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Fig1: Kaplan–Meier estimates of a the hospitalization-free survival, b operation-free survival, c overall survival, and d survival from hospital discharge (i.e., excluding patients who died within 30 days after admission). p values were calculated with the log rank test. Age- and sex-adjusted p values were calculated with multivariate Cox proportional-hazards regression analysis

Mentions: Two patients (1.5 %) in the surgical group and one (1.2 %) in the conservative group required operation to treat further SBO recurrence. Overall, 44 patients (32.4 %) died in the surgical group and 15 (17.6 %) in the conservative group. The age- and sex-adjusted HR for surgery was 1.5; 95 % CI, 0.8–2.7; p = 0.196. When considering only death occurring more than 30 days after SBO surgery or conservative management initiation (i.e., excluding postoperative death), the age- and sex-adjusted HR (95 % CI) was 1.1 (0.6–2.1); p = 0.690. Kaplan–Meier estimates of the hospitalization-free survival, operation-free survival, overall survival, and survival from the date of hospital discharge (>30 days after admission) are shown in Fig. 1.Fig. 1


Clinical outcome in acute small bowel obstruction after surgical or conservative management.

Meier RP, de Saussure WO, Orci LA, Gutzwiller EM, Morel P, Ris F, Schwenter F - World J Surg (2014)

Kaplan–Meier estimates of a the hospitalization-free survival, b operation-free survival, c overall survival, and d survival from hospital discharge (i.e., excluding patients who died within 30 days after admission). p values were calculated with the log rank test. Age- and sex-adjusted p values were calculated with multivariate Cox proportional-hazards regression analysis
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4232739&req=5

Fig1: Kaplan–Meier estimates of a the hospitalization-free survival, b operation-free survival, c overall survival, and d survival from hospital discharge (i.e., excluding patients who died within 30 days after admission). p values were calculated with the log rank test. Age- and sex-adjusted p values were calculated with multivariate Cox proportional-hazards regression analysis
Mentions: Two patients (1.5 %) in the surgical group and one (1.2 %) in the conservative group required operation to treat further SBO recurrence. Overall, 44 patients (32.4 %) died in the surgical group and 15 (17.6 %) in the conservative group. The age- and sex-adjusted HR for surgery was 1.5; 95 % CI, 0.8–2.7; p = 0.196. When considering only death occurring more than 30 days after SBO surgery or conservative management initiation (i.e., excluding postoperative death), the age- and sex-adjusted HR (95 % CI) was 1.1 (0.6–2.1); p = 0.690. Kaplan–Meier estimates of the hospitalization-free survival, operation-free survival, overall survival, and survival from the date of hospital discharge (>30 days after admission) are shown in Fig. 1.Fig. 1

Bottom Line: Five-year mortality from the date of hospital discharge was not significantly different between the two groups (age- and sex-adjusted HR, 1.1; 95 % CI, 0.6-2.1).Among them, 24 patients (34.8 %) of the surgical group and 35 patients (57.4 %) of the conservative group had recurrent SBO symptoms (odds ratio, 0.4; 95 % CI, 0.2-0.8).The recurrence of SBO symptoms and new hospitalizations were significantly lower after surgical management of SBO compared with conservative treatment.

View Article: PubMed Central - PubMed

Affiliation: Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland, Raphael.Meier@hcuge.ch.

ABSTRACT

Background: Small bowel obstruction (SBO) is characterized by a high rate of recurrence. In the present study, we aimed to compare the outcomes of patients managed either by conservative treatment or surgical operation for an episode of SBO.

Methods: The outcomes of all patients hospitalized at a single center for acute SBO between 2004 and 2007 were assessed. The occurrence of recurrent hospitalization, surgery, SBO symptoms at home, and mortality was determined.

Results: Among 221 patients admitted with SBO, 136 underwent a surgical procedure (surgical group) and 85 were managed conservatively (conservative group). Baseline characteristics were similar between treatment groups. The median follow-up time (interquartile range) was 4.7 (3.7-5.8) years. Nineteen patients (14.0 %) of the surgical group were hospitalized for recurrent SBO versus 25 (29.4 %) of the conservative group [hazard ratio (HR), 0.5; 95 % CI, 0.3-0.9]. The need for a surgical management of a new SBO episode was similar between the two groups, ten patients (7.4 %) in the surgical group and six patients (7.1 %) in the conservative group (HR, 1.1; 95 % CI, 0.4-3.1). Five-year mortality from the date of hospital discharge was not significantly different between the two groups (age- and sex-adjusted HR, 1.1; 95 % CI, 0.6-2.1). A follow-up evaluation was obtained for 130 patients. Among them, 24 patients (34.8 %) of the surgical group and 35 patients (57.4 %) of the conservative group had recurrent SBO symptoms (odds ratio, 0.4; 95 % CI, 0.2-0.8).

Conclusions: The recurrence of SBO symptoms and new hospitalizations were significantly lower after surgical management of SBO compared with conservative treatment.

Show MeSH
Related in: MedlinePlus