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Factors That Predict Failure of Non-Operative Management of Small Bowel Obstructions
John Kubasiak*, Elizabeth Blears, Benjamin Veenstra, Amanda Francescatti, Jonathan Myers, Keith W. Millikan, Daniel J. Deziel, Minh B. Luu
General Surgery, Rush University, Chicago, IL
Background:
Small bowel obstructions account for 15-20% of all acute surgical hospitalizations. Patients with partial bowel obstructions from adhesive disease are initially managed with nasogastric tube decompression, bowel rest and intravenous fluid resuscitation, if signs and symptoms of ischemia are not present. This conservative management fails in upwards of 30% of patients. Given this failure rate, investigators have developed a scoring system that may predict this failure. The purpose of this study is to identify factors which may predict failure of non-operative management of small bowel obstruction.
Methods:
The University Healthcare Consortium database was queried for all patients with small bowel obstructions on a surgical service during 2009 (n=186). Patients were divided into two cohorts: those whose small bowel obstruction resolved with conservative management (n=123) and those who failed conservative management and required surgery (n=63). Patient groups were compared using two-group t-tests for quantitative variables and chi-square tests for categorical variables. Logistic regression analysis was used to determine whether any single parameter can predict failure of conservative management.
Results:
We were unable to reproduce the predictive findings in previous scoring systems. Initial CT findings including small bowel (SB) lumen, SB feces sign, SB wall thickness, mesenteric edema, SB transition point were not predictive of non-operative failure, The only significant predictor of failing conservative management was the number of CT scan findings Having two or more findings doubled the risk of failing non-operative management (OR=2.067, CI= 1.012-4.22). No physical exam findings at initial exam or laboratory values were predictive for failure of non-operative management.
Conclusion:
No single factor was predictive of failure of non-operative management of small bowel obstruction. Two or more CT scan findings may suggest the need for surgical intervention.
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