The postoperative incidence of small bowel obstruction following standard, open appendectomy and cholecystectomy: a six-year retrospective cohort study at Yale-New Haven Hospital.
The incidence of postoperative small bowel obstruction (SBO) after standard, open appendectomy and cholecystectomy was calculated during a six-year period at a university medical center hospital, which is the larger of two local, community hospitals. A cohort of 567 patients who underwent either a standard, open appendectomy or cholecystectomy from 1 October 1985 through 30 September 1986 was assembled. Of these patients, 182 (32.1%) were readmitted to the hospital prior to 1 October 1991 and thereby received follow-up. The time-related incidence of readmission to the hospital with a specific diagnosis of SBO as estimated by the Kaplan-Meier method was tabulated. This analysis revealed the following incidence rates of postoperative SBO: 10.7% following appendectomy during 64 months of follow-up (n = 41) and 6.4% following cholecystectomy during 67 months (n = 141). The Kaplan-Meier product-limit incidence of postoperative SBO was significantly different for standard appendectomy versus standard cholecystectomy (Breslow-Cox P value < 0.0277). This implies that the anatomical position and/or the likelihood of perioperative infection associated with open, abdominal surgery plays a significant role in subsequent adhesion formation and development of SBO. These data may be compared to laparoscopic techniques in future studies.
Zbar
R I
RI
Department of Surgery, Yale University School of Medicine, New Haven.
Crede
W B
WB
McKhann
C F
CF
Jekel
J F
JF
D001062:Appendectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D002763:Cholecystectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D015331:Cohort Studies; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology*; D007421:Intestine, Small; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis