title: Prevalence and risk factors of mortality and morbidity after operation for adhesive postoperative small bowel obstruction.
abstract: BACKGROUND
  Many factors are believed to influence the mortality and morbidity after operations for adhesive small bowel obstruction (SBO).
  
  
  METHODS
  In a multicenter prospective cohort of 286 patients operated on for adhesive postoperative SBO, we studied the in-hospital and 30-day postdischarge mortality (early mortality) and morbidity as well as long-term mortality using univariate and multivariate analysis.
  
  
  RESULTS
  In the present cohort, with a median follow-up of 41 months and 9% patients lost to follow-up at the end of the study, the prevalence of early postoperative mortality was 3%. All deceased patients were over 75 years old with an American Society of Anesthesiologists (ASA) class >/=III. The prevalence of long-term mortality was 7% with the following independent risk factors: age >75 years old (hazards ratio [HR] 6.6 [95% confidence interval [CI], 2.4-18.1]), medical complications (HR 7.4 [CI, 2.2-24.3]), and a mixed mechanism of obstruction (HR 4.5 [CI, 1.5-13.7]). Prevalence of medical and surgical morbidity was 8% and 6%, respectively. Independent risk factors for medical complications were ASA class >/=III (odds ratio [OR] 16.8 [CI, 2.1-133.1]) and bands (OR 14.1 [CI, 1.8-111.5]) and for the surgical complications the number of obstructive structures >/=10 (OR 8.3 [CI, 1.6-19.7]), a nonresected intestinal wall injury (OR 5.3 [CI, 1.5-18.3]), and intestinal necrosis (OR 5.6 [CI, 1.6-19.7]). Otherwise, 3 patients with "apparent" reversible ischemia developed a postoperative intestinal necrosis followed by 2 reoperations and 1 death.
  
  
  CONCLUSIONS
  The early postoperative mortality is strongly linked with the age and the ASA class and the long-term mortality with postoperative complications. More frequent bowel resections might be suggested for patients featuring a number of obstructive structures >/=10 and an intestinal wall injury, especially when associated with a reversible intestinal ischemia.
authors: Department of General Surgery University Hospital La Pitié, Paris, France. jean-jacques.duron@psl.aphp.fr
authors: Jean-Jacques
authors: JJ
authors: Duron
authors: Sophie Tezenas
authors: ST
authors: du Montcel
authors: Anne
authors: A
authors: Berger
authors: Fabrice
authors: F
authors: Muscari
authors: Henri
authors: H
authors: Hennet
authors: Michel
authors: M
authors: Veyrieres
authors: Jean Marie
authors: JM
authors: Hay
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010532:Peritoneal Diseases / Q000601:surgery; D011183:Postoperative Complications; D012307:Risk Factors; D015996:Survival Rate; D000267:Tissue Adhesions / Q000150:complications / Q000601:surgery