Table 1.
Patient characteristics
| Variable | Surgical management (n = 136) | Conservative management (n = 85) | p valuea |
|---|---|---|---|
| Age, years (mean ± SD) | 68.4 ± 18.4 | 64.7 ± 16.5 | 0.133 |
| Sex, male (%) | 52 (38.2) | 38 (44.7) | 0.399 |
| Previous abdominal operation (%) | 121 (89.0) | 80 (94.1) | 0.234 |
| Patients with previous surgery (%) | |||
| 0 abdominal operation | 15 (11.0) | 5 (5.9) | 0.120 |
| 1 abdominal operation | 56 (41.2) | 28 (32.9) | |
| 2 or more abdominal operations | 65 (47.8) | 52 (61.2) | |
| Previous appendectomy (%) | 63 (46.3) | 41 (48.2) | 0.784 |
| Previous cholecystectomy (%) | 21 (15.4) | 14 (16.5) | 0.852 |
| Previous colorectal surgery (%) | 25 (18.4) | 24 (28.2) | 0.097 |
| Previous gynecologic surgery (%) | 26 (19.1) | 21 (24.7) | 0.398 |
| Previous urologic surgery (%) | 8 (5.9) | 7 (8.2) | 0.585 |
| Previous hernia repair (%) | 18 (13.2) | 7 (8.2) | 0.283 |
| Previous gastric surgery (%) | 11 (8.1) | 4 (4.7) | 0.417 |
| Previous small bowel surgery (%) | 5 (3.7) | 6 (7.1) | 0.342 |
| Previous vascular surgery (%) | 2 (1.5) | 3 (3.5) | 0.375 |
| Previous operation for cancer (%) | 22 (16.2) | 12 (14.1) | 0.707 |
| Previous SBO episode(s) managed surgically (%) | 4 (2.9) | 4 (4.7) | 0.488 |
| Previous SBO episode(s) managed conservatively (%) | 14 (10.3) | 15 (17.6) | 0.151 |
| Clinical severity score (%)b | |||
| 0 | 10 (7.4) | 15 (17.6) | <0.001 |
| 1 | 31 (22.8) | 30 (35.3) | |
| 2 | 46 (33.8) | 33 (38.8) | |
| 3 | 38 (27.9) | 6 (7.1) | |
| 4 | 10 (7.4) | 1 (1.2) | |
| 5 | 1 (0.7) | 0 (0.0) | |
| 6 | 0 (0.0) | 0 (0.0) | |
| Decision making for surgical management (%) | |||
| CT transition zone | 83 (61.0) | NA | NA |
| Clinical degradationc | 23 (16.9) | ||
| CT: volvulus | 18 (13.2) | ||
| CT: reduced contrast enhancement | 8 (5.9) | ||
| Otherd | 4 (2.9) | ||
| Delay before surgery ≥24 h (%) | 17 (12.5) | NA | NA |
| Small bowel resection (%) | 44 (32.4) | NA | NA |
| Length of index hospital stay, days (mean ± SD) | 12.0 ± 8.5 | 6.6 ± 3.6 | <0.001 |
| Death during the index hospital stay (%)e | 9 (6.6) | 0 (0.0) | 0.014 |
Recorded during the index hospitalization for a SBO episode
SD standard deviation, NA not applicable, SBO small bowel obstruction
aStudent’s t test for continuous variables, χ2 test for binary or categorical variable (global p value)
bCalculated as described by Schwenter et al. 2010. One point was given for each present feature: pain duration ≥4 days, abdominal guarding, leukocyte count ≥10 × 109/l, C-reactive protein ≥75 mg/l, free fluid ≥500 ml on CT scan, reduced contrast enhancement on CT scan. The score ranged from 0 to 6
cDevelopment of peritonism, no flatus after 24 h of observation, or hemodynamic instability
dIncludes diffuse small bowel feces sign (n = 1), small bowel dilatation >4.5 cm (n = 1), SB wall major inflammation (n = 2)
eDeath occurring ≤30 days after SBO surgery or conservative management initiation