In-hospital small bowel obstruction after exploratory laparotomy for trauma.
BACKGROUND
The purpose of this study was to examine the incidence and risk factors of in-hospital small bowel obstruction (SBO) after exploratory laparotomy for trauma.


METHODS
A retrospective review of patients surviving over 72 hours after an exploratory laparotomy for trauma. Patients with intestinal obstructive symptoms were reviewed by a consensus panel, which evaluated the clinical, laboratory, and radiologic findings to validate the diagnosis of SBO.


RESULTS
A total of 571 patients met inclusion criteria. The incidence of early SBO was 3.9%, with 22.7% of these patients requiring surgical intervention. Patients with gastrointestinal (GI) perforation had a significantly higher incidence of SBO, compared with those with no GI perforation (5.7% vs. 1.3%, p = 0.007). A forward logistic regression identified the presence of a GI perforation as the only factor independently associated with early SBO (adjusted odds ratio: 4.39; 95% confidence interval: 1.28-15.15; p = 0.019). The overall hospital stay was significantly longer for SBO patients (27.0 days ± 26.7 days vs. 16.0 days ± 22.8 days; adjusted mean difference: 11.5; 95% confidence interval: 1.6-21.3; p = 0.022). Development of SBO increased the cost by 59.7%.


CONCLUSIONS
The incidence of in-hospital SBO after laparotomy for trauma is significant at 3.9%. The presence of a GI perforation is independently associated with the development of this complication. Over a fifth of patients with early SBO will require a surgical intervention. The use of preventive strategies may be justified in selected, high-risk patients to reduce the burden associated with early SBO.
Division of Trauma Surgery and Surgical Critical Care, Los Angeles County Medical Center, University of Southern California, Los Angeles, California 90033, USA.
Galinos
G
Barmparas
Bernardino C
BC
Branco
Beat
B
Schnüriger
Matthew
M
Oliver
Agathoklis
A
Konstantinidis
Thomas
T
Lustenberger
Barbara M
BM
Eberle
Kenji
K
Inaba
Demetrios
D
Demetriades
D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000453:epidemiology*; D007416:Intestinal Perforation / Q000453:epidemiology; D007813:Laparotomy; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D014947:Wounds and Injuries / Q000601:surgery*; D055815:Young Adult