Predictors of medical treatment failure in patients with adhesive small bowel obstruction.

IF 2.4 3区 医学 Q2 SURGERY
Sofía Bertona, María A Casas, Josefina Principe, Sofía Aramburu, Cristian A Angeramo, Andrés Zanfardini, Francisco Schlottmann
{"title":"Predictors of medical treatment failure in patients with adhesive small bowel obstruction.","authors":"Sofía Bertona, María A Casas, Josefina Principe, Sofía Aramburu, Cristian A Angeramo, Andrés Zanfardini, Francisco Schlottmann","doi":"10.1007/s13304-025-02311-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Small bowel obstruction (SBO) is a common cause of hospitalization worldwide with approximately 80% of cases resulting from surgical adhesions. While medical treatment is often advocated for SBO, some patients require surgical intervention. The aim of this study was to evaluate predictors of medical treatment failure in patients with adhesive SBO (ASBO).</p><p><strong>Methods: </strong>We performed a retrospective analysis of a consecutive series of patients with ASBO between 2014 and 2024. The sample was divided into two groups; patients who resolved with conservative treatment (G1) and those who required surgical intervention after initial conservative management (G2). Demographic and preoperative variables were compared between groups. A multivariable logistic regression analysis was performed to identify independent factors associated with medical treatment failure.</p><p><strong>Results: </strong>A total of 225 patients were included; 125 (55.5%) belonged to G1 and 100 (45.5%) to G2. Demographic and laboratory variables were similar between groups, except for mean lactate levels, which were higher in G2 (G1: 0.5 vs G2: 1.1 mmol/L), p = 0.001). Patients in G1 had higher number of previous ASBO episodes (G1: 47 (37.6%) vs. G2: 20 (20.0%), p = 0.004). Previous open surgery (G1: 89 (71.2%) vs. G2: 86 (86%), p = 0.007) and open appendectomy (G1: 16 (12.8%) vs. G2: 24 (24%), p = 0.02) as surgical history were more frequent in G2. Time elapsed since symptoms onset was longer in G2 (G1: 2.2 vs. G2: 2.7 days, p = 0.001). An abrupt transition point (G1:86 (71%) vs. G2: 85 (86.7%), p = 0.005) and a beak sign (G1: 48 (39.6%) vs. G2: 52 (53%), p = 0.04) on CT scan were more frequently observed in G2. In the multivariate analysis, the presence of a transition point on CT (OR 2.25, IC 95% 1.07-4.71, p < 0.03), higher lactic acid levels (OR 1.37, IC 95% 1.07-1.77, p < 0.01), and history of previous open surgery (OR 2.55, IC 95% 1.23-5.30, p < 0.01) were independent predictors of treatment failure. History of multiple previous episodes of ASBO treated successfully with medical treatment (OR 0.43, IC 95% 0.23-0.84, p < 0.01) was associated with medical treatment success. After 50.8 months of follow-up, recurrence of ASBO was higher in G1 (G1: 16 (12.8%) vs G2: 1 (5%), p = 0.04).</p><p><strong>Conclusion: </strong>ASBO in patients with a transition point on CT, high lactic acid levels, and/or history of previous open operation is significantly less likely to respond to medical treatment. Closer monitoring and early consideration of surgical intervention in these patients might be reasonable to reduce potential morbidity and mortality associated with delayed surgery.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Updates in Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s13304-025-02311-0","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Small bowel obstruction (SBO) is a common cause of hospitalization worldwide with approximately 80% of cases resulting from surgical adhesions. While medical treatment is often advocated for SBO, some patients require surgical intervention. The aim of this study was to evaluate predictors of medical treatment failure in patients with adhesive SBO (ASBO).

Methods: We performed a retrospective analysis of a consecutive series of patients with ASBO between 2014 and 2024. The sample was divided into two groups; patients who resolved with conservative treatment (G1) and those who required surgical intervention after initial conservative management (G2). Demographic and preoperative variables were compared between groups. A multivariable logistic regression analysis was performed to identify independent factors associated with medical treatment failure.

Results: A total of 225 patients were included; 125 (55.5%) belonged to G1 and 100 (45.5%) to G2. Demographic and laboratory variables were similar between groups, except for mean lactate levels, which were higher in G2 (G1: 0.5 vs G2: 1.1 mmol/L), p = 0.001). Patients in G1 had higher number of previous ASBO episodes (G1: 47 (37.6%) vs. G2: 20 (20.0%), p = 0.004). Previous open surgery (G1: 89 (71.2%) vs. G2: 86 (86%), p = 0.007) and open appendectomy (G1: 16 (12.8%) vs. G2: 24 (24%), p = 0.02) as surgical history were more frequent in G2. Time elapsed since symptoms onset was longer in G2 (G1: 2.2 vs. G2: 2.7 days, p = 0.001). An abrupt transition point (G1:86 (71%) vs. G2: 85 (86.7%), p = 0.005) and a beak sign (G1: 48 (39.6%) vs. G2: 52 (53%), p = 0.04) on CT scan were more frequently observed in G2. In the multivariate analysis, the presence of a transition point on CT (OR 2.25, IC 95% 1.07-4.71, p < 0.03), higher lactic acid levels (OR 1.37, IC 95% 1.07-1.77, p < 0.01), and history of previous open surgery (OR 2.55, IC 95% 1.23-5.30, p < 0.01) were independent predictors of treatment failure. History of multiple previous episodes of ASBO treated successfully with medical treatment (OR 0.43, IC 95% 0.23-0.84, p < 0.01) was associated with medical treatment success. After 50.8 months of follow-up, recurrence of ASBO was higher in G1 (G1: 16 (12.8%) vs G2: 1 (5%), p = 0.04).

Conclusion: ASBO in patients with a transition point on CT, high lactic acid levels, and/or history of previous open operation is significantly less likely to respond to medical treatment. Closer monitoring and early consideration of surgical intervention in these patients might be reasonable to reduce potential morbidity and mortality associated with delayed surgery.

粘连性小肠梗阻患者治疗失败的预测因素
背景:小肠梗阻(SBO)是世界范围内住院的常见原因,大约80%的病例是由手术粘连引起的。虽然通常提倡对SBO进行药物治疗,但有些患者需要手术干预。本研究的目的是评估黏附性SBO (ASBO)患者治疗失败的预测因素。方法:我们对2014年至2024年间连续一系列ASBO患者进行回顾性分析。样本被分为两组;接受保守治疗的患者(G1)和在初始保守治疗后需要手术干预的患者(G2)。组间比较人口学和术前变量。进行多变量logistic回归分析以确定与医疗失败相关的独立因素。结果:共纳入225例患者;G1 125例(55.5%),G2 100例(45.5%)。组间人口统计学和实验室变量相似,除了G2组的平均乳酸水平较高(G1: 0.5 vs G2: 1.1 mmol/L), p = 0.001)。G1组患者既往ASBO发作次数较多(G1: 47次(37.6%)vs. G2: 20次(20.0%),p = 0.004)。既往开放手术(G1: 89例(71.2%)vs. G2: 86例(86%),p = 0.007)和开放阑尾切除术(G1: 16例(12.8%)vs. G2: 24例(24%),p = 0.02), G2的手术史更频繁。G2患者出现症状后的时间更长(G1: 2.2天vs. G2: 2.7天,p = 0.001)。CT扫描上突变点(G1:86 (71%) vs. G2: 85 (86.7%), p = 0.005)和喙征(G1: 48 (39.6%) vs. G2: 52 (53%), p = 0.04)在G2中更常见。在多因素分析中,CT上存在过渡点(OR 2.25, IC 95% 1.07-4.71, p)结论:CT上存在过渡点、高乳酸水平和/或既往开放手术史的ASBO患者对药物治疗的反应明显较低。对这些患者进行更密切的监测和早期考虑手术干预可能是合理的,以减少与延迟手术相关的潜在发病率和死亡率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Updates in Surgery
Updates in Surgery Medicine-Surgery
CiteScore
4.50
自引率
7.70%
发文量
208
期刊介绍: Updates in Surgery (UPIS) has been founded in 2010 as the official journal of the Italian Society of Surgery. It’s an international, English-language, peer-reviewed journal dedicated to the surgical sciences. Its main goal is to offer a valuable update on the most recent developments of those surgical techniques that are rapidly evolving, forcing the community of surgeons to a rigorous debate and a continuous refinement of standards of care. In this respect position papers on the mostly debated surgical approaches and accreditation criteria have been published and are welcome for the future. Beside its focus on general surgery, the journal draws particular attention to cutting edge topics and emerging surgical fields that are publishing in monothematic issues guest edited by well-known experts. Updates in Surgery has been considering various types of papers: editorials, comprehensive reviews, original studies and technical notes related to specific surgical procedures and techniques on liver, colorectal, gastric, pancreatic, robotic and bariatric surgery.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信