Relationship between duration of preoperative symptoms and postoperative ileus for small bowel obstruction

Whitney S Brandt; Joshua Wood; Bishwajit Bhattacharya; Kevin Pei; Kimberly A Davis; Kevin Schuster

doi:10.1016/j.jss.2017.12.031

Relationship between duration of preoperative symptoms and postoperative ileus for small bowel obstruction

J Surg Res. 2018 May:225:40-44. doi: 10.1016/j.jss.2017.12.031. Epub 2018 Jan 30.

Authors

Whitney S Brandt¹, Joshua Wood², Bishwajit Bhattacharya², Kevin Pei², Kimberly A Davis², Kevin Schuster²

Affiliations

¹ Department of Surgery and New Haven, Sections of General Surgery, Trauma and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut. Electronic address: whitney.brandt@yale.edu.
² Department of Surgery and New Haven, Sections of General Surgery, Trauma and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut.

PMID: 29605033
DOI: 10.1016/j.jss.2017.12.031

Abstract

Background: Factors associated with postoperative ileus and increased resource utilization for patients who undergo operative intervention for small-bowel obstruction are not extensively studied. We evaluated the association between total duration of preoperative symptoms and postoperative outcomes in this population.

Materials and methods: We performed a retrospective review of patients who underwent surgery for small-bowel obstruction (2013-2016). Clinical data were recorded. Total duration of preoperative symptoms included all symptoms before operation, including those before presentation. Primary endpoint was time to tolerance of diet. Secondary endpoints included length of stay, total parenteral nutrition use, and intensive care unit admission. Association between variables and outcomes was analyzed using univariable analysis, multivariable Poisson modeling, and t-test to compare groups.

Results: Sixty-seven patients were included. On presentation, the median duration of symptoms before hospitalization was 2 d (range 0-18 d). Total duration of preoperative symptoms was associated with time to tolerance of diet on univariable analysis (Pearson's moment correlation: 0.28, 95% confidence interval: 0.028-0.5, P = 0.03). On multivariable analysis, ascites was correlated with time to tolerance of diet (P < 0.01), but total duration of preoperative symptoms (P = 0.07) was not. Length of stay (Pearson's correlation: 0.24, 95% confidence interval: -0.02 to 0.47, P = 0.07) was not statistically different in patients with longer preoperative symptoms. Symptom duration was not statistically associated with intensive care unit (P = 0.18) or total parenteral nutrition (P = 0.3) utilization.

Conclusions: Our findings demonstrate that preoperative ascites correlated with increased time to tolerance of diet, and duration of preoperative symptoms may be related to postoperative ileus.

Keywords: Adhesiolysis; Length of stay; Postoperative ileus; Small-bowel obstruction (SBO); Utilization of resources.

MeSH terms

Adult
Aged
Aged, 80 and over
Ascites / epidemiology
Ascites / etiology
Ascites / surgery
Equipment and Supplies Utilization / economics
Equipment and Supplies Utilization / statistics & numerical data
Female
Food Intolerance / epidemiology
Food Intolerance / etiology
Food Intolerance / surgery
Humans
Ileus / economics
Ileus / epidemiology*
Ileus / etiology
Intensive Care Units / economics
Intensive Care Units / statistics & numerical data
Intestinal Obstruction / complications
Intestinal Obstruction / surgery*
Intestine, Small / physiopathology
Intestine, Small / surgery
Length of Stay / economics
Length of Stay / statistics & numerical data
Male
Middle Aged
Parenteral Nutrition / economics
Parenteral Nutrition / statistics & numerical data
Postoperative Complications / economics
Postoperative Complications / epidemiology*
Postoperative Complications / etiology
Preoperative Period
Retrospective Studies
Risk Factors
Time Factors
Time-to-Treatment / statistics & numerical data*
Young Adult