Predictors of Management Outcomes in Pathological Small Bowel Surgical Emergencies: A Prospective Study in a Busy Emergency Unit | ||||
| The Medical Journal of Cairo University | ||||
| Article 82, Volume 89, September, September 2021, Page 2057-2067 PDF (782.49 K) | ||||
| DOI: 10.21608/mjcu.2021.203344 | ||||
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| Authors | ||||
| AHMED M. HASSAN, M.D.; AHMED NABIL, M.D.; M.R.C.S. (Eng); SAMUEL NEMR, M.Sc.; HESHAM AMER, M.D.; AYMAN M.A. OSMAN, M.D., M.R.C.S. (Eng) | ||||
| The Department of General Surgery, Faculty of Medicine, Cairo University, Egypt | ||||
| Abstract | ||||
| Abstract Background: The management of pathological small bowel disorders in the emergency department is challenging, and is linked to higher morbidity and mortality rates. Aim of Study: The aim of this study was to identify the main factors that could help predict the management outcomes in pathological small bowel surgical emergencies (PSBSEs). Patients and Methods: All patients presenting with PSBSEs to the Emergency Unit over a 6-months period were prospec-tively studied. Data about patient-related, assessment-related, pathology-related, and management-related variables; 90-day morbidity; as well as mortality were all recorded. Univariate and multivariate analyses were carried out to identify the predictors of management outcomes in PSBSEs. Results: Our study included 107 patients. The most fre-quently encountered PSBSEs were obstruction and/or stran-gulation (64 cases, 59.8%). Management was operative in 88 cases (82.2%). Overall, 30 cases (28%) developed morbidity, and 7 cases (6.5%) died. In univariate analysis, 14 different factors were associated with a significantly increased risk of morbidity; whereas in multivariate analysis, only 5 factors were found to be significant predictors of 90-day morbidity. The highest odds of morbidity were associated with re-operation [Odds Ratio (OR)=11.2, 95% CI=6.7-18.3, p=0.001] and hemodynamic status [OR=9.7, 95% CI=2.8-21.5, p=0.001]. Conclusion: Constant abdominal pain at presentation, hemodynamic instability, midline surgical incision, operative time >!2 hours, and re-operation were all associated with a significantly increased risk of 90-day morbidity in patients with PSBSEs. | ||||
| Keywords | ||||
| Predictors; Outcomes; Pathological small bowel emergencies | ||||
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