Complications and death after surgical treatment of small bowel obstruction - A 35-year institutional experience

Objective To study factors influencing complications and death after operations for s mall bower obstruction (SBO) using multifactorial statistical methods. Summary Background Data Death after surgery for SBO is believed to be influenced by factors such as old age, comorbidities, bowel gangrene; and delay in treatment. No studies have been reported in which adverse factors related to death and complicat ions have been systematically investigated with modern statistical methods. Methods The authors studied retrospectively 877 patients who underwent 1,007 operat ions for SBO from 1961 to 1995, Patients with paralytic ileus, intussuscept ion, and abdominal cancer were excluded. Odds ratios for death, complicatio ns, postoperative hospital stay, and strangulation were calculated by means of logistic regression analyses. Results Death and complication rates decreased during the study period. Old age, comorbidity, nonviable strangulation, and a treatment delay of more t han 24 hours were significantly associated with an increased death rate. Th e rate of nonviable strangulation increased markedly with patient age. Majo r factors increasing the complication rate were old age, comorbidity, a tre atment delay of more than 24 hours, and the need for repeat surgery. Conclusion Death and complication rates after SBO decreased from 1961 to 19 95. Major factors influencing the rates were age, comorbidity, nonviable st rangulation, and treatment delay. Nonviable strangulation was more common i n old patients.