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Surgery Improves Survival Among Patients With Intestinal Obstruction
Smith, Brian Patrick
Smith, Brian Patrick
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Thesis/Dissertation
Date
2010
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Clinical Research and Translational Medicine
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http://dx.doi.org/10.34944/dspace/2398
Abstract
Introduction: Intestinal obstruction is a common cause of hospital admissions and carries a mortality rate around 5%. We hypothesized that surgical intervention reduces mortality among these patients. Methods: We conducted a retrospective cohort study using the 2006 Nationwide Inpatient Sample (NIS) to analyze patients with a diagnosis of intestinal obstruction without hernia. We used multiple variable logistic regression to calculate the odds ratio for surgery as a predictor of death after adjusting for illness severity. Results: Among 38,931 patients, 17,544 (45.1%) underwent operative intervention for intestinal obstructions. Surgical patients were slightly younger than non-surgical patients (65 vs. 68 years), and had more severe illness, as measured by the disease staging: mortality scale (115.45 vs. 97.95, p<0.001). After adjusting for illness severity, surgery was protective from mortality (adjusted odds ratio 0.617, 95% CI 0.535-0.710, p<0.001). This finding was validated with 2 other methods of severity adjustment. Among surgery patients, there were fewer days to surgery among survivors (1 day) than non-survivors (2 days), p<0.001. The risk of bowel necrosis increased as time from admission to surgery increased. A greater percentage of surgical patients (77.5%) were discharged home compared to non-surgical patients (76.3%), p=0.007. Conclusion: Surgery is associated with a reduced odds of in-hospital mortality among patients urgently or emergently admitted with intestinal obstruction without hernia. Delaying operative intervention is associated with an increased odds of bowel necrosis and death in these patients.
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