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Adhesive small bowel obstruction in octogenarians: A 6-year retrospective single-center analysis of clinical management and outcomes

  • Author Footnotes
    1 Giuseppe Quero and Davide De Sio share the first authorship.
    Giuseppe Quero
    Footnotes
    1 Giuseppe Quero and Davide De Sio share the first authorship.
    Affiliations
    Digestive Surgery Unit, Department of Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy

    Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168, Rome, Italy
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  • Author Footnotes
    1 Giuseppe Quero and Davide De Sio share the first authorship.
    Davide De Sio
    Footnotes
    1 Giuseppe Quero and Davide De Sio share the first authorship.
    Affiliations
    Digestive Surgery Unit, Department of Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
    Search for articles by this author
  • Marcello Covino
    Affiliations
    Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168, Rome, Italy

    Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
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  • Claudio Fiorillo
    Affiliations
    Digestive Surgery Unit, Department of Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
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  • Vito Laterza
    Correspondence
    Corresponding author. Digestive Surgery Unit Fondazione Policlinico Universitario “Agostino Gemelli”, IRCCS Largo Agostino Gemelli, 8, 00168, Rome, Italy.
    Affiliations
    Digestive Surgery Unit, Department of Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
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  • Carlo Alberto Schena
    Affiliations
    Digestive Surgery Unit, Department of Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
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  • Fausto Rosa
    Affiliations
    Digestive Surgery Unit, Department of Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy

    Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168, Rome, Italy
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  • Roberta Menghi
    Affiliations
    Digestive Surgery Unit, Department of Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy

    Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168, Rome, Italy
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  • Luigi Carbone
    Affiliations
    Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
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  • Andrea Piccioni
    Affiliations
    Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
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  • Francesco Franceschi
    Affiliations
    Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168, Rome, Italy

    Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
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  • Sergio Alfieri
    Affiliations
    Digestive Surgery Unit, Department of Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy

    Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168, Rome, Italy
    Search for articles by this author
  • Author Footnotes
    1 Giuseppe Quero and Davide De Sio share the first authorship.

      Highlights

      • The correct management of ASBO in the elderly is still unknown.
      • Upfront surgery in over 80 years patients relates with worse outcomes.
      • Conservative management in octogenarians is safe and feasible.
      • Failure of the conservative management in over 80 years patients do not lead to worse outcomes than upfront surgery.

      Abstract

      Background

      Few evidences are available on adhesive bowel obstruction (ASBO)management and outcomes in geriatric patients.

      Methods

      One-hundred-twenty-eight patients aged 65–79 years were retrospectively compared to 77 patients aged ≥80 years. Aim of this study was to compare ASBO management and in-hospital course between patients aged 65–79 years and those over 80 years.

      Results

      Upfront surgery in octogenarians related with a higher rate of major complications (23.7%vs4.9%; p = 0.009) and longer hospitalization (8.8vs7.3 days; p = 0.01). No difference according to age was noted in terms of clinical outcomes when the non-operative management (NOM) was employed. Patients aged ≥80 years managed conservatively presented shorter hospitalization (7.3vs8.8 days; p = 0.04), lower rate of intensive care unit (ICU)admission (0vs18.4%; p = 0.005) and cumulative major complications (2.6%vs23.7%; p = 0.007) as compared to ≥80 years old patients treated with upfront surgery. In this same group, NOM failure did not lead to worse outcomes in comparison to upfront surgery.

      Conclusions

      NOM in≥80 years patients is associated with better in-hospital course. The acceptable clinical outcomes in case of NOM failure further support NOM as first treatment strategy to employ in this same subset of patients.

      Keywords

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      References

        • Eurostat Statistic Explained
        Index @ Ec.Europa.Eu. Online. Published Online.
        2021
        • Maung A.A.
        • Johnson D.C.
        • Piper G.L.
        • et al.
        Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline.
        Journal of Trauma and Acute Care Surgery. 2012; 73: 362-369https://doi.org/10.1097/TA.0b013e31827019de
        • Scott J.W.
        • Olufajo O.A.
        • Brat G.A.
        • et al.
        Use of national burden to define operative emergency general surgery.
        JAMA Surgery. 2016; 151: 1-8https://doi.org/10.1001/jamasurg.2016.0480
        • NELA Project Team
        The Second Patient Report of the National Emergency Laparotomy Audit (NELA) December 2014 to November 2015 the Second Patient Report of the National Emergency Laparotomy Audit (NELA).
        2016 (November 2015)
        • Di Saverio S.
        • Coccolini F.
        • Galati M.
        • et al.
        Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group.
        World J Emerg Surg. 2013; 8: 1-14https://doi.org/10.1186/1749-7922-8-42
        • Evers B.M.
        • Townsend C.M.
        • Thompson J.C.
        Organ physiology of aging.
        Surg Clin. 1994; 74: 23-39https://doi.org/10.1016/S0039-6109(16)46226-2
        • Charlson M.E.
        A new method of classifying prognostic in longitudinal studies : development.
        J Chron Dis. 1987; 40: 373-383
        • Di Saverio S.
        • Coccolini F.
        • Galati M.
        • et al.
        Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group.
        World J Emerg Surg. 2013; 8: 1-14https://doi.org/10.1186/1749-7922-8-42
        • Broek R.P.G.
        • Krielen P.
        • Di Saverio S.
        • et al.
        Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO).
        World J Emerg Surg. 2018; 13: 13-24
        • Ozturk E.
        • van Iersel M.
        • Stommel M.M.W.J.
        • Schoon Y.
        • ten Broek R.R.P.G.
        • van Goor H.
        Small bowel obstruction in the elderly: a plea for comprehensive acute geriatric care.
        World J Emerg Surg. 2018; 13https://doi.org/10.1186/s13017-018-0208-z
        • Krause W.R.
        • Webb T.P.
        Geriatric small bowel obstruction: an analysis of treatment and outcomes compared with a younger cohort.
        Am J Surg. 2015; 209: 347-351https://doi.org/10.1016/j.amjsurg.2014.04.008
        • Springer J.E.
        • Bailey J.G.
        • Davis P.J.B.
        • Johnson P.M.
        Management and outcomes of small bowel obstruction in older adult patients: a prospective cohort study.
        Can J Surg. 2014; 57: 379-384https://doi.org/10.1503/cjs.029513
        • Dang C.
        • Aguilera P.
        • Dang A.
        • Salem L.
        Acute abdominal pain: four classifications can guide assessment and management.
        Geriatrics. 2002; 57: 30-42
        • Kay L.
        Abdominal symptoms, visits to the doctor, and medicine consumption among the elderly. A population based study.
        Dan Med Bull. 1994; 41: 466-469
        • Lyon C.
        • Clark D.C.
        Diagnosis of acute abdominal pain in older patients.
        Am Fam Physician. 2006; 74: 1537-1544
        • McNamara R.M.
        • Rousseau E.
        • Sanders A.B.
        Geriatric emergency medicine: a survey of practicing emergency physicians.
        Ann Emerg Med. 1992; 21: 796-801https://doi.org/10.1016/S0196-0644(05)81024-8
        • Vogt D.P.
        The acute abdomen in the geriatric patient.
        Cleve Clin J Med. 1990; 57: 125-130https://doi.org/10.3949/ccjm.57.2.125
        • Quero G.
        • Covino M.
        • Laterza V.
        • et al.
        Adhesive small bowel obstruction in elderly patients: a single-center analysis of treatment strategies and clinical outcomes.
        Scand J Gastroenterol. 2021; 56: 784-790https://doi.org/10.1080/00365521.2021.1921256
        • Aitken R.M.
        • Partridge J.S.L.
        • Oliver C.M.
        • et al.
        Older patients undergoing emergency laparotomy: observations from the national emergency laparotomy Audit (NELA) years 1-4.
        Age Ageing. 2020; 49https://doi.org/10.1093/ageing/afaa075
        • Bugliosi T.F.
        • Meloy T.D.
        • Vukov L.F.
        • Foundation M.
        A c u t e Abdominal Pain in the Elderly.
        1990: 1383-1386 (December)
        • Fenyö G.
        Acute abdominal disease in the elderly. Experience from two series in Stockholm.
        Am J Surg. 1982; 143: 751-754https://doi.org/10.1016/0002-9610(82)90052-6
        • Laurell H.
        • Hansson L.E.
        • Gunnarsson U.
        Acute abdominal pain among elderly patients.
        Gerontology. 2006; 52: 339-344https://doi.org/10.1159/000094982
        • Quero G.
        • Covino M.
        • Fiorillo C.
        • et al.
        Acute pancreatitis in elderly patients: a single-center retrospective evaluation of clinical outcomes.
        Scand J Gastroenterol. 2019; 54: 492-498https://doi.org/10.1080/00365521.2019.1588369
        • Quero G.
        • Covino M.
        • Ojetti V.
        • et al.
        Acute pancreatitis in oldest old: a 10-year retrospective analysis of patients referred to the emergency department of a large tertiary hospital.
        Eur J Gastroenterol Hepatol. 2020; 32: 159-165https://doi.org/10.1097/MEG.0000000000001570
        • Laurell H.
        • Hansson L.E.
        • Gunnarsson U.
        Acute abdominal pain among elderly patients.
        Gerontology. 2006; 52: 339-344https://doi.org/10.1159/000094982
        • Catananti C.
        • Gambassi G.
        Pain assessment in the elderly.
        Surgical Oncology. 2010; 19https://doi.org/10.1016/j.suronc.2009.11.010
        • Karanikas I.D.
        • Liakakos T.D.
        • Koundourakis S.S.
        • Tzorakis S.E.
        • Dendrinos S.S.
        Emergency operations in the management and outcome.
        Int Surg. 1996; 81: 158-162
        • McIntyre R.
        • Reinbach D.
        • Cuschieri R.J.
        Emergency abdominal surgery in the elderly.
        J R Coll Surg Edinb. 1997; 42: 173-178
        • Neary W.D.
        • Foy C.
        • Heather B.P.
        • Earnshaw J.J.
        Identifying high-risk patients undergoing urgent and emergency surgery.
        Ann R Coll Surg Engl. 2006; 88: 151-156https://doi.org/10.1308/003588406X94896
        • Rosa F.
        • Covino M.
        • Cozza V.
        • et al.
        Management of acute cholecystitis in elderly patients: a propensity score-matched analysis of surgical vs. medical treatment.
        Dig Liver Dis. 2021; 53: 1620-1626https://doi.org/10.1016/j.dld.2021.01.011
        • Quero G.
        • Covino M.
        • Fiorillo C.
        • et al.
        Acute pancreatitis in elderly patients: a single-center retrospective evaluation of clinical outcomes.
        Scand J Gastroenterol. 2019; 54: 492-498https://doi.org/10.1080/00365521.2019.1588369
        • Quero G.
        • Covino M.
        • Ojetti V.
        • et al.
        Acute pancreatitis in oldest old: a 10-year retrospective analysis of patients referred to the emergency department of a large tertiary hospital.
        Eur J Gastroenterol Hepatol. 2020; 32: 159-165https://doi.org/10.1097/MEG.0000000000001570
        • Haider S.I.
        • Johnell K.
        • Thorslund M.
        • Fastbom J.
        Trends in polypharmacy and potential drug-drug interactions across educational groups in elderly patients in Sweden for the period 1992 - 2002.
        Int J Clin Pharm Ther. 2007; 45: 643-653https://doi.org/10.5414/CPP45643
        • Hovstadius B.
        • Hovstadius K.
        • Åstrand B.
        • Petersson G.
        Increasing polypharmacy - an individual-based study of the Swedish population 2005-2008.
        BMC Clin Pharmacol. 2010; 10: 16https://doi.org/10.1186/1472-6904-10-16
        • Shader R.
        • Greenblatt D.
        The use of benzodiazepines in clinical practice.
        Br J Clin Pharmacol. 1981; 11: 5S-9Shttps://doi.org/10.1111/j.1365-2125.1981.tb01832.x
        • Mehvar R.
        • Brocks D.R.
        Stereospecific pharmacokinetics and pharmacodynamics of beta-adrenergic blockers in humans.
        J Pharm Pharmaceut Sci. 2001; 4: 185-200
        • Lee M.J.
        • Sayers A.E.
        • Drake T.M.
        • et al.
        National prospective cohort study of the burden of acute small bowel obstruction.
        BJS Open. 2019; 3https://doi.org/10.1002/bjs5.50136
        • Ozturk E.
        • van Iersel M.
        • Stommel M.M.W.J.
        • Schoon Y.
        • ten Broek R.R.P.G.
        • van Goor H.
        Small bowel obstruction in the elderly: a plea for comprehensive acute geriatric care.
        World J Emerg Surg. 2018; 13https://doi.org/10.1186/s13017-018-0208-z
        • Schraufnagel D.
        • Rajaee S.
        • Millham F.H.
        How many sunsets? Timing of surgery in adhesive small bowel obstruction: a study of the Nationwide Inpatient Sample.
        Journal of Trauma and Acute Care Surgery. 2013; 74: 181-189https://doi.org/10.1097/TA.0b013e31827891a1
        • Foster N.M.
        • McGory M.L.
        • Zingmond D.S.
        • Ko C.Y.
        Small bowel obstruction: a population-based appraisal.
        J Am Coll Surg. 2006; 203: 170-176https://doi.org/10.1016/j.jamcollsurg.2006.04.020
        • Peacock O.
        • Bassett M.G.
        • Kuryba A.
        • et al.
        Thirty-day mortality in patients undergoing laparotomy for small bowel obstruction.
        Br J Surg. 2018; 105https://doi.org/10.1002/bjs.10812