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Early Operation is Associated With a Survival Benefit For Patients With Adhesive Bowel Obstruction
Pedro G Teixeira*, Efstathios Karamanos*, Peep Talving*, Kenji Inaba*, Lydia Lam*, Demetrios Demetriades
University of Southern California, Los Angeles, CA

Objectives: It is generally accepted that patients with uncomplicated adhesive bowel obstruction (ABO) failing nonoperative management should be operated on within 5 days. However, the optimal time of operation within this 5-day period is unknown. This study evaluates the effect of timing of operation after admission on outcomes.
Methods: Patients requiring surgery for ABO were identified from NSQIP. Linear regression was performed to evaluate the impact of incremental surgical delay in mortality and complications. The study population was stratified by time to intervention (24 hour intervals) and logistic regression was performed to adjust for pre-morbid conditions and presentation physiology. The outcomes included 30-day mortality and infectious complications.
Results: 4,163 patients underwent laparotomy for ABO. Mortality and complications increased significantly with operative delay (Figure). Delay >= 24 hours was associated with significantly higher mortality (6.5% vs. 3.0%, adjusted odds ratio (AOR) [95%CI]: 1.58 [1.12, 2.24], p=0.009). The delayed operation group (>=24 hours) also had significantly higher rates of surgical site infections (12.9% vs. 10.0%, AOR [95%CI]: 1.33 [1.08-1.62], p=0.007), pneumonia (7.9% vs. 5.2%, AOR [95%CI]: 1.36 [1.04-1.78], p=0.025), sepsis (7.6% vs. 5.1%, AOR [95%CI]: 1.45 [1.10-1.90], p=0.007), and septic shock (6.2% vs. 3.5%, AOR [95%CI]: 1.47 [1.07-2.02], p=0.018).
Conclusion: Early operative intervention for patients with adhesive bowel obstruction is associated with a significant survival benefit and lower incidence of local and systemic complications.


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