Surgical Outcomes in Patients With Malignant Small Bowel Obstruction
| Autor: | Adrienne N. Bruce, Yun Song, Rachel R. Kelz, Robert S. Krouse, Giorgos C. Karakousis, Robert E. Roses, Daniel Aryeh Metzger, Douglas L. Fraker |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Population Digestive System Neoplasms Rate ratio Postoperative Complications Internal medicine Intestine Small medicine Humans Hypoalbuminemia Propensity Score education Aged Retrospective Studies education.field_of_study business.industry Mortality rate Area under the curve Odds ratio Length of Stay Middle Aged medicine.disease Quality Improvement United States Survival Rate Bowel obstruction Female Laparoscopy Surgery Morbidity Complication business Intestinal Obstruction Follow-Up Studies |
| Zdroj: | Annals of Surgery. 275:e198-e205 |
| ISSN: | 1528-1140 0003-4932 |
| Popis: | OBJECTIVE The study objectives were to characterize surgical outcomes for malignant small bowel obstruction (MaSBO) as compared to other small bowel obstructions (SBO) and to develop a prediction model for postoperative mortality for MaSBO. SUMMARY BACKGROUND DATA MaSBO is a morbid complication of advanced cancers for which the optimal management remains undefined. METHODS Patients who underwent surgery for MaSBO or SBO were identified from the National Surgical Quality Improvement Program (2005-2017). Outcomes [30-day morbidity, unplanned readmissions, mortality, postoperative length of stay (LOS)] were compared between propensity score-matched MaSBO and SBO patients. An internally validated prediction model for mortality in MaSBO patients was developed. RESULTS Of 46,706 patients, 1612 (3.5%) had MaSBO. Although MaSBO patients were younger than those with SBO (median 63 vs 65 years, P < 0.001), they were otherwise more clinically complex, including a higher proportion with recent weight loss (22.0% vs 4.0%, P < 0.001), severe hypoalbuminemia (18.6% vs 5.2%, P < 0.001), and cytopenias. After matching (N = 1609/group), MaSBO was associated with increased morbidity [odds ratio (OR) 1.2, P = 0.004], but not readmission (OR 1.1, P = 0.48) or LOS (incidence rate ratio 1.0, P = 0.14). The odds of mortality were significantly higher for MaSBO than SBO (OR 3.3, P < 0.001). A risk-score model predicted postoperative mortality for MaSBO with an optimism-adjusted Brier score of 0.114 and area under the curve of 0.735. Patients in the highest-risk category (11.5% of MaSBO population) had a predicted mortality rate of 39.4%. CONCLUSION Surgery for MaSBO is associated with substantial morbidity and mortality, necessitating careful patient evaluation before operative intervention. |
| Databáze: | OpenAIRE |
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