Survey of Diagnostic and Management Practices in Small Bowel Obstruction: Individual and Generational Variation Despite Practice Guidelines.

Autor:	Fakhry SM; Center for Trauma and Acute Care Surgery Research, Clinical Services Group, HCA Healthcare, Nashville, TN, USA., Duane TM; Department of Surgery, Medical City Plano, Plano, TX, USA., Garland JM; Center for Trauma and Acute Care Surgery Research, Clinical Services Group, HCA Healthcare, Nashville, TN, USA., Dunne JR; Department of Trauma and Surgical Critical Care, Memorial Health University Medical Center, Savannah, GA, USA., Kurek SJ; Trauma Services, Chippenham Hospital, Richmond, VA, USA., Hunt DL; Department of Surgery, Tristar Skyline Medical Center, Nashville, TN, USA., Plurad DS; Department of Surgery, Riverside Community Hospital, Riverside, CA, USA., Shillinglaw WC; Department of Surgery, Mission Hospital, Asheville, NC, USA., Carrick MM; Department of Surgery, Medical City Plano, Plano, TX, USA., Lieser MJ; Department of Trauma Surgery, Research Medical Center, Kansas City, MO, USA., Wyse RJ; Center for Trauma and Acute Care Surgery Research, Clinical Services Group, HCA Healthcare, Nashville, TN, USA., Wilson NY; Center for Trauma and Acute Care Surgery Research, Clinical Services Group, HCA Healthcare, Nashville, TN, USA., Watts DD; Center for Trauma and Acute Care Surgery Research, Clinical Services Group, HCA Healthcare, Nashville, TN, USA.
Jazyk:	angličtina
Zdroj:	The American surgeon [Am Surg] 2023 Dec; Vol. 89 (12), pp. 5545-5552. Date of Electronic Publication: 2023 Feb 28.
DOI:	10.1177/00031348231160851
Abstrakt:	Background: Small bowel obstruction (SBO) is a common disorder managed by surgeons. Despite extensive publications and management guidelines, there is no universally accepted approach to its diagnosis and management. We conducted a survey of acute care surgeons to elucidate their SBO practice patterns. Methods: A self-report survey of SBO diagnosis and management practices was designed and distributed by email to AAST surgeons who cared for adult SBO patients. Responses were analyzed with descriptive statistics and Chi-square test of independence at α = .05. Results: There were 201 useable surveys: 53% ≥ 50 years, 77% male, 77% at level I trauma centers. Only 35.8% reported formal hospital SBO management guidelines. Computed tomography (CT) scan was the only diagnostic exam listed as "essential" by the majority of respondents (82.6%). Following NG decompression, 153 (76.1%) would "always/frequently" administer a water-soluble contrast challenge (GC). There were notable age differences in approach. Compared to those ≥50 years, younger surgeons were less likely to deem plain abdominal films as "essential" (16.0% vs 40.2%; P < .01) but more likely to require CT scan (88.3% vs 77.6%; P = .045) for diagnosis and to "always/frequently" administer GC (84.0% vs 69.2%; P < .01). Younger surgeons used laparoscopy "frequently" more often than older surgeons (34.0% vs 21.5%, P = .05). Discussion: There is significant variation in diagnosis and management of SBO among respondents in this convenience sample, despite existing PMGs. Novel age differences in responses were observed, which prompts further evaluation. Additional research is needed to determine whether variation in practice patterns is widespread and affects outcomes . Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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