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
- Index @ Ec.Europa.Eu. Online. Published Online.2021
- 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
- Use of national burden to define operative emergency general surgery.JAMA Surgery. 2016; 151: 1-8https://doi.org/10.1001/jamasurg.2016.0480
- 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)
- 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
- Organ physiology of aging.Surg Clin. 1994; 74: 23-39https://doi.org/10.1016/S0039-6109(16)46226-2
- A new method of classifying prognostic in longitudinal studies : development.J Chron Dis. 1987; 40: 373-383
- 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
- Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO).World J Emerg Surg. 2018; 13: 13-24
- 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
- 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
- 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
- Acute abdominal pain: four classifications can guide assessment and management.Geriatrics. 2002; 57: 30-42
- Abdominal symptoms, visits to the doctor, and medicine consumption among the elderly. A population based study.Dan Med Bull. 1994; 41: 466-469
- Diagnosis of acute abdominal pain in older patients.Am Fam Physician. 2006; 74: 1537-1544
- 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
- The acute abdomen in the geriatric patient.Cleve Clin J Med. 1990; 57: 125-130https://doi.org/10.3949/ccjm.57.2.125
- 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
- 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
- A c u t e Abdominal Pain in the Elderly.1990: 1383-1386 (December)
- 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
- Acute abdominal pain among elderly patients.Gerontology. 2006; 52: 339-344https://doi.org/10.1159/000094982
- 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
- 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
- Acute abdominal pain among elderly patients.Gerontology. 2006; 52: 339-344https://doi.org/10.1159/000094982
- Pain assessment in the elderly.Surgical Oncology. 2010; 19https://doi.org/10.1016/j.suronc.2009.11.010
- Emergency operations in the management and outcome.Int Surg. 1996; 81: 158-162
- Emergency abdominal surgery in the elderly.J R Coll Surg Edinb. 1997; 42: 173-178
- Identifying high-risk patients undergoing urgent and emergency surgery.Ann R Coll Surg Engl. 2006; 88: 151-156https://doi.org/10.1308/003588406X94896
- 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
- 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
- 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
- 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
- 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
- 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
- Stereospecific pharmacokinetics and pharmacodynamics of beta-adrenergic blockers in humans.J Pharm Pharmaceut Sci. 2001; 4: 185-200
- National prospective cohort study of the burden of acute small bowel obstruction.BJS Open. 2019; 3https://doi.org/10.1002/bjs5.50136
- 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
- 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
- Small bowel obstruction: a population-based appraisal.J Am Coll Surg. 2006; 203: 170-176https://doi.org/10.1016/j.jamcollsurg.2006.04.020
- Thirty-day mortality in patients undergoing laparotomy for small bowel obstruction.Br J Surg. 2018; 105https://doi.org/10.1002/bjs.10812
Article Info
Publication History
Published online: April 21, 2022
Accepted:
April 19,
2022
Received in revised form:
April 11,
2022
Received:
February 27,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
