title: Laparoscopic Versus Open Bowel Resection in Emergency Small Bowel Obstruction: Analysis of the National Surgical Quality Improvement Program Database.
abstract: BACKGROUND
  Small bowel obstruction (SBO) is commonly encountered by surgeons and has traditionally been handled via an open approach, especially when small bowel resection (SBR) is indicated, although recent series have shown improved outcomes with a laparoscopic approach. In this retrospective study, we sought to evaluate outcomes and identify risk factors for adverse events after emergency SBR for SBO with an emphasis on surgical approach.
  
  
  METHODS
  In this retrospective review using American College of Surgeons National Surgical Quality Improvement Program data, 1750 patients were identified who had emergency SBR with the principal diagnosis of SBO from 2006 to 2011. Mortality and postoperative adverse events were evaluated.
  
  
  RESULTS
  Of 1750 patients who had emergency SBR, 51 (2.9%) had laparoscopic bowel resection (LBR). There was no difference in surgery duration (open bowel resection [OBR] versus LBR, 100 minutes versus 92 minutes; P=.38). Compared with the LBR group, the OBR group had a higher rate of baseline cardiac comorbidities and postoperative complications, and their length of stay was longer (10 versus 8 days; P<.001). Using multivariate analysis, perioperative variables of age >70 years, pulmonary, renal, neurological, and cardiac comorbidities, preoperative sepsis, steroid use, and body mass index of <30 kg/m(2) were associated with increased odds of mortality. OBR was associated with overall increased odds of morbidity (2.8; P=.003) and postoperative wound (2.9; P=.018) and respiratory (6.5; P=.011) infections.
  
  
  CONCLUSIONS
  LBR was associated with equivalent operative time, shorter length of stay, less morbidity, and equivalent mortality compared with OBR. Although therapy for SBO secondary to adhesive disease remains controversial, our study shows numerous benefits to the laparoscopic approach to SBOs and thus should be considered a first-line treatment option for the management of this common surgical problem.
authors.affiliation: 1 Santa Barbara Cottage Hospital , Santa Barbara, California.
authors.forename: Rohit
authors.initials: R
authors.lastname: Sharma
authors.affiliation: 2 Cleveland Clinic , Cleveland, Ohio.
authors.forename: Subhash
authors.initials: S
authors.lastname: Reddy
authors.affiliation: 1 Santa Barbara Cottage Hospital , Santa Barbara, California.
authors.forename: David
authors.initials: D
authors.lastname: Thoman
authors.affiliation: 1 Santa Barbara Cottage Hospital , Santa Barbara, California.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Grotts
authors.affiliation: 1 Santa Barbara Cottage Hospital , Santa Barbara, California.
authors.forename: Lisa
authors.initials: L
authors.lastname: Ferrigno
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D004630:Emergencies; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D007415:Intestinal Obstruction / Q000401:mortality* / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D007674:Kidney Diseases / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology; D061646:Operative Time; D012141:Respiratory Tract Infections / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology*; D014481:United States / Q000453:epidemiology