title: A scoring system for the prognosis and treatment of malignant bowel obstruction.
abstract: BACKGROUND
  Malignant bowel obstruction is a common result of end-stage abdominal cancer that is a treatment dilemma for many physicians. Little has been reported predicting outcomes or determining the role of surgical intervention. We sought to review our experience with surgical and nonsurgical management of malignant bowel obstruction to identify predictors of 30-day mortality and of who would most likely benefit from surgical intervention.
  
  
  METHODS
  A chart review of 523 patients treated between 2000 and 2007 with malignant bowel obstruction were evaluated for factors present at admission to determine return to oral intake, 30-day mortality, and overall survival. Propensity score matching was used to homogenize patients treated with and without surgery to identify those who would benefit most from operative intervention.
  
  
  RESULTS
  Radiographic evidence of large bowel obstruction was predictive of return to oral intake. Hypoalbuminemia and radiographic evidence of ascites or carcinomatosis were all predictive of increased 30-day mortality and overall survival. A nomogram of 5 identified risk factors correlated with increased 30-day mortality independent of therapy. Patients with large bowel or partial small bowel obstruction benefited most from surgery. A second nomogram was created from 4 identified risk factors that revealed which patients with complete small bowel obstruction might benefit from surgery.
  
  
  CONCLUSIONS
  Two nomograms were created that may guide decisions in the care of patients with malignant bowel obstruction. These nomograms are able to predict 30-day mortality and who may benefit from surgery for small bowel obstruction.
authors.affiliation: Division of Surgical Oncology, The Ohio State University College of Medicine, Columbus, OH 43210-1240, USA.
authors.forename: Jon C
authors.initials: JC
authors.lastname: Henry
authors.forename: Severin
authors.initials: S
authors.lastname: Pouly
authors.forename: Rachael
authors.initials: R
authors.lastname: Sullivan
authors.forename: Suhail
authors.initials: S
authors.lastname: Sharif
authors.forename: Dori
authors.initials: D
authors.lastname: Klemanski
authors.forename: Sherif
authors.initials: S
authors.lastname: Abdel-Misih
authors.forename: Nicole
authors.initials: N
authors.lastname: Arradaza
authors.forename: David
authors.initials: D
authors.lastname: Jarjoura
authors.forename: Carl
authors.initials: C
authors.lastname: Schmidt
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
mesh_terms: D000008:Abdominal Neoplasms / Q000150:complications* / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome