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    Surgery Improves Survival Among Patients With Intestinal Obstruction

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    Genre
    Thesis/Dissertation
    Date
    2010
    Author
    Smith, Brian Patrick
    Advisor
    Seamon, Mark J.
    Committee member
    Parkman, Henry P.
    Nelson, Deborah B.
    Department
    Clinical Research and Translational Medicine
    Subject
    Health Sciences, Medicine and Surgery
    Bowel Obstruction
    Intestinal Obstruction
    Mortality
    Non-operative
    Sugery
    Permanent link to this record
    http://hdl.handle.net/20.500.12613/2416
    
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    DOI
    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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