title: Predictive factors of early bowel obstruction in colon and rectal surgery: data from the Nationwide Inpatient Sample, 2006-2008.
abstract: BACKGROUND
  Early postoperative bowel obstruction is associated with considerable morbidity and mortality after colorectal surgery. We evaluated the impact of patient characteristics, patient comorbidities, pathology, resection site, surgical technique, admission type, and teaching hospital status on the incidence of in-hospital bowel obstruction after colorectal surgery.
  
  
  METHODS
  Using the Nationwide Inpatient Sample database, we examined the clinical data of patients who underwent colorectal resection from 2006 to 2008. Regression analyses were performed to identify factors predictive of in-hospital bowel obstruction.
  
  
  RESULTS
  A total of 975,825 patients underwent colorectal resection during this period. Overall, the rate of postoperative bowel obstruction was 8.65% (elective surgery: 5.32% vs emergent surgery: 13.26%; p < 0.01). Bowel obstruction was less frequent after laparoscopic procedures compared with open procedures (6.61% vs 8.81%; p < 0.01). Using multivariate regression analysis, Crohn disease (adjusted odds ratio [AOR] = 12.32), emergent surgery (AOR = 2.54), malignant tumor (AOR = 1.84), diverticulitis (AOR = 1.45), age older than 65 years (AOR = 1.22), female sex (AOR = 1.14), history of alcohol abuse (AOR = 1.12), transverse colectomy (AOR = 1.11), peripheral vascular disease (AOR = 1.07), left colectomy (AOR = 1.06), chronic lung disease (AOR = 1.05), open procedure (AOR = 1.05), African-American race (AOR = 1.03), and teaching hospital (AOR = 1.02) were associated with a higher risk of in-hospital bowel obstruction. There was no association between hypertension, diabetes, congestive heart failure, chronic renal failure, liver disease, obesity, smoking, proctectomy or total colectomy, and early bowel obstruction.
  
  
  CONCLUSIONS
  Early bowel obstruction is a relatively common complication after colorectal surgery. Crohn disease patients had a 12-fold higher incidence of early bowel obstruction, and emergent surgery and malignancy were relevant predictors of early bowel obstruction.
authors.affiliation: Department of Surgery, University of California, Irvine School of Medicine, Irvine, CA, USA.
authors.forename: Hossein
authors.initials: H
authors.lastname: Masoomi
authors.forename: Celeste Y
authors.initials: CY
authors.lastname: Kang
authors.forename: Obaid
authors.initials: O
authors.lastname: Chaudhry
authors.forename: Alessio
authors.initials: A
authors.lastname: Pigazzi
authors.forename: Steven
authors.initials: S
authors.lastname: Mills
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Carmichael
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
mesh_terms: D000368:Aged; D000437:Alcoholism / Q000453:epidemiology; D015984:Causality; D003107:Colorectal Surgery / Q000009:adverse effects / Q000706:statistics & numerical data*; D003424:Crohn Disease / Q000453:epidemiology; D004238:Diverticulitis / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data; D007415:Intestinal Obstruction / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012044:Regression Analysis; D012307:Risk Factors