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 21 February 2018

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News

Surgery delay increases resection risk in complete obstruction

Surgery should not be postponed beyond 24 hours for unresponsive symptoms from complete obstruction, as the risk of resection rises dramatically, reports the latest Journal of the American College of Surgeons.

News image

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Little is known about the effect of passing time on risk of resection among patients with complete small bowel obstruction.

Dr Nina Bickell and colleagues from New York explored the relationship of time on the risk of bowel resection with complete small bowel obstruction.

The researchers performed an observational study of patients with surgically treated complete small bowel obstruction.

The team retrospectively sampled 60 patients randomly, and 81 prospectively, for a final sample of 141.

Detailed clinical and time data were abstracted from medical records including out-of-hospital examinations.

Risk of resection was 4% with 24 hours of unresponsive symptoms vs 14% at 96hours
Journal of the American College of Surgeons

The researchers calculated risk of resection using actuarial life table methods.

Linear regression was used to determine factors affecting time to treatment.

All patients were treated surgically for obstruction, and 45% underwent resection.

The researchers found that resected patients had longer hospital stays of 11days versus 8 day for non-resected patients.

The resected patients also had more complicated hospital stays, with 31% in intensive care vs 14% who were not treated surgically.

The team noted that the risk of resection was 4% among patients with 24 hours of unresponsive symptoms.

This increased to 10% then 14% through 96 hours, after which it dropped slightly but did not disappear.

The researchers observed that patients treated first with a tube had longer times between first examination and operation, system-time.

However, the team noted that this was not associated with an increased resection risk.

System-times were shorter among patients seen first in the emergency department.

Dr Bickell's team concludes, “Physicians should be cautious in postponing surgery beyond 24hours in patients with unresponsive symptoms from complete obstruction.”

“The risk of resection rises dramatically, remains elevated through 96 hours of unresolved symptoms, then declines but does not disappear.”

J Am Coll Surg 2005: 201(6): 847-54
28 November 2005

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