Factors affecting outcome of small bowel obstruction surgery

To construct risk indices predicting adverse outcomes following surgery for small bowel obstruction [SBO]. The VA National Surgical Quality Improvement Program contains prospectively collected data on more than 1 million patients. Patients undergoing adhesiolysis only or small bowel resection for SBO from 1991 to 2002 were selected. Independent variables included 68 presurgical and 12 intraoperative risk factors; dependent variables were 21 adverse outcomes including death. Stepwise logistic regression was used to construct models predicting 30-day morbidity and mortality and to derive risk index values. Patients were then divided into risk classes. Results: Of the 2002 patients, 1650 underwent adhesiolysis only and 352 underwent small bowel resection. Thirty-seven percent undergoing adhesiolysis only and 47% undergoing small bowel resection had more than 1 complication [p< 0.001]. The overall 30-day mortality was 7, 7% and did not differ significantly between the groups. Odds of death were highest for dirty or infected wounds, ASA class 4 or 5, age >80 years and dyspnea at rest. Morbidity ranged from 22%, among patients with 0 to 7 risk points, to 62% for those with >19 risk points. Mortality ranged from 2% among patients with 0 to 12 risk points to 28% for those with >31 risk points. Morbidity and mortality after surgery for SBO in VA hospitals are comparable with those in other large series. The morbidity rate, hut not the mortality rate, is significantly higher in patients requiring small bowel resection compared with those requiring adhesiolysis only [p<0.001]. The risk indices presented provide an easy-to-use tool for clinicians to predict outcomes for patients undergoing surgery for SBO

Intra-abdominal sepsis complicating abdominal trauma

Identifying patients with risk factors associated with the development of intra-abdominal infections makes possible early interventions to minimize morbidity and mortality. We sought to determine the incidence of intra-abdominal infection [organ/space surgical site infection] in patients undergoing operation because of abdominal trauma, to identify the risk factors associated with the development of this complication and to estimate the respective magnitudes of the risk factors. We performed a prospective cohort study in patients older than 16 years who were treated surgically for penetrating or blunt abdominal trauma, with or without other associated lesions. 116 patients with abdominal trauma were admitted to the department of surgery. Of these, we excluded 2 [1.7%] who underwent operation at different institutions; 9 [7.8%] who died within 48 hours after admission and 5 [4.3%] in whom complete follow-up [until the 30th postoperative day] was not feasible. The final study sample consisted of 100 patients. Main Outcome Measure: We performed univariate analysis to explore in an isolated way the behavior of the dependent and independent variables. Bivariate analysis was carried out with each of the independent variables and the main outcome to establish the association between individual risk factors and intra-abdominal infection. Finally, a logistic regression model was developed using the SPSS 10.0 program and the forward method. Intra-abdominal infection developed in 10 patients [10%]. Variables independently associated with this complication were an Abdominal Trauma index greater than 24, abdominal contamination and admission to the intensive care unit. The development of intra-abdominal infection in patients undergoing operation because of abdominal trauma is a complex phenomenon resulting from the multiple risk factors during the preoperative, intraoperative and postoperative periods. Multivariate logistic regression analysis allowed us to identify an Abdominal Trauma Index greater than 24, contamination of the abdominal cavity, and admission to the intensive care unit as independent risk factors for the development of organ/space surgical site infection