Risk factors of mortality after surgical treatment of intestinal obstruction in patients having prior laparotomy for non-malignancy.
BACKGROUND
Intestinal obstruction has remained one of the most common surgical emergencies, and its clinical spectrum has shifted in past decades. The factors contributing to its surgical mortality were studied in these selected patients with a view to finding pointers which help surgeons to identify patients with high surgical risk of mortality.


METHODS
Those adult patients who had prior laparotomy for non-malignancy and were operated on for intestinal obstruction were included and studied retrospectively. Thirteen possible risk factors, including co-existing medical illness, tachycardia, preoperative shock, age, bowel ischemia, operative complication, leukocytosis, durations from symptom onset to hospitalization, from hospitalization to operation, and from symptom onset to operation, prior laparotomy number, time interval from last laparotomy to this operation, and operation method, were analyzed using univariate analysis and, then, multivariate analysis to find out the independent risk factors for surgical death.


RESULTS
Adhesion-related etiologies were the most common. Still, one-tenth of cases were not adhesion-related. Obstruction in the small bowel (172/176) was more frequent than in the large bowel (4/176). The surgical mortality rate was 6.8% (12/176). The independent risk factors of mortality after surgical treatment were co-existing medical illness, bowel ischemia, preoperative shock, and operative complication. Old age seemed to be a risk factor on univariate anlaysis, but not on multivariate analysis. Duration from symptom onset to hospitalization, from hospitalization to operation, or from symptom onset to operation was not significantly related to surgical mortality.


CONCLUSIONS
High risk patients could be identified by 4 independent factors: coexisting medical illness, bowel ischemia, preoperative shock, and operative complication. Old age itself was not an independent risk factor.
Chou
Nan-Hua
NH
Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC. nhchou@isca.vghks.gov.tw
Mok
King-Tong
KT
Wang
Being-Whey
BW
Chang
Hong-Tai
HT
Hsu
Ping-I
PI
D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D007813:Laparotomy; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors