Impact of gastrografin in clinical practice in the management of adhesive small bowel obstruction.
BACKGROUND
Gastrografin (GG) has been shown to accelerate the resolution of adhesive small bowel obstruction (ASBO) and decrease length of stay (LOS) in hospital. Consequently, we instituted a protocol recommending the routine use of GG in patients with ASBO. This study reviews patient outcomes after protocol implementation.


METHODS
We conducted a retrospective review of all patients with ASBO from January 1997 to December 2007. Data were categorized by admission date and use of GG. The outcomes reviewed were protocol uptake, median LOS in hospital and operative rate. Results were analyzed using the Mann-Whitney U test and the 2-tailed Fisher exact test.


RESULTS
There were 710 patients with ASBO overall. Sixteen of 376 (4.3%) patients received GG before institution of the protocol (period 1), whereas 195 of 334 (58.4%) received GG thereafter (period 2). In period 2, use of GG was limited to between 58% and 69% of all potentially eligible patients per year. Fifty-seven of 710 (8%) patients required surgery. In period 1, there were no significant differences in median LOS in hospital (p=0.29) and operative rate (p=0.65) between patients who received GG and those who were managed without GG. In period 2, patients receiving GG had a greater median LOS in hospital (3 [range 2-5] v. 2 [range 1-5] d, p=0.048) but significantly lower operative rates (5.1% v. 12.9%, p=0.018). Overall, the median LOS decreased over time (period 1: 4 [2-7] d v. period 2: 2 [1-5] d, p=0.010). The operative rate did not vary substantially between periods (7.7% v. 8.4%, p=0.42).


CONCLUSIONS
The introduction of a protocol has increased the proportion of eligible patients receiving GG. However, protocol nonadherence and factors other than GG usage have influenced LOS in hospital and operative rates. Demonstrated benefits from previously published clinical trials have thus not been replicated within our setting.
Department of Surgery, South Auckland Clinical School, University of Auckland, Auckland, New Zealand.
Sanket
S
Srinivasa
Nainoor
N
Thakore
Saleh
S
Abbas
Maryam
M
Mahmood
Arman Adam
AA
Kahokehr
Andrew G
AG
Hill
D002985:Clinical Protocols; D003287:Contrast Media / Q000627:therapeutic use*; D003974:Diatrizoate Meglumine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000267:Tissue Adhesions
D003287:Contrast Media; D003974:Diatrizoate Meglumine
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