title: Management and outcomes of small bowel obstruction in older adult patients: a prospective cohort study.
abstract: BACKGROUND
  The purpose of this research was to examine the morbidity, mortality and rate of recurrent bowel obstruction associated with the treatment of small bowel obstruction (SBO) in older adults.
  
  
  METHODS
  We prospectively enrolled all patients 70 years or older with an SBO who were admitted to a tertiary care teaching centre between Jul. 1, 2011, and Sept. 30, 2012. Data regarding presentation, investigations, treatment and outcomes were collected.
  
  
  RESULTS
  Of the 104 patients admitted with an SBO, 49% were managed nonoperatively and 51% underwent surgery. Patients who underwent surgery experienced more complications (64% v. 27%, p = 0.002) and stayed in hospital longer (10 v. 3 d, p < 0.001) than patients managed nonoperatively. Nonoperative management was associated with a high rate of recurrent SBO: 31% after a median follow-up of 17 months. Of the patients managed operatively, 60% underwent immediate surgery and 40% underwent surgery after attempted nonoperative management. Patients in whom nonoperative management failed underwent surgery after a median of 2 days, and 89% underwent surgery within 5 days. The rate of bowel resection was high (29%) among those who underwent delayed surgery. Surgery after failed nonoperative management was associated with a mortality of 14% versus 3% for those who underwent immediate surgery; however, this difference was not significant.
  
  
  CONCLUSIONS
  These data suggest that some elderly patients with SBO may be waiting too long for surgery.
authors.affiliation: The Division of General Surgery, Dalhousie University, Halifax, NS.
authors.forename: Jeremy E
authors.initials: JE
authors.lastname: Springer
authors.affiliation: The Division of General Surgery, Dalhousie University, Halifax, NS.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Bailey
authors.affiliation: The Division of General Surgery, Dalhousie University, Halifax, NS.
authors.forename: Philip J B
authors.initials: PJ
authors.lastname: Davis
authors.affiliation: The Division of General Surgery and the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Johnson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D007421:Intestine, Small / Q000473:pathology* / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome