title: Postoperative outcomes in patients with perforated bowel: early versus late intervention.
abstract: Time to intervention is suggested to be a crucial factor for a number of surgical conditions. In this study, we aim to examine the postoperative outcomes associated with the timing of surgical intervention in patients with perforated bowel.
  
  
  
  Cross-sectional study using the Nationwide Inpatient Sample database, 2003-2010. The study population included adult (≥18 y) inpatients who had perforated intestine or colon and underwent bowel surgery.
  
  
  
  A total of 5412 (64.6%) patients who had an early surgical intervention on same day of admission and 2985 (35.4%) patients who had a delayed surgery were included. Patients with comorbidities or those in hospitals in the Northeast region of the United States were more likely to have a delayed intervention (P < 0.01). In low-risk patients who are aged <65 y old and with no comorbidities, the timing of surgery did not associate with the risk of postoperative complications (P = 0.77) and mortality (P = 0.08), whereas in high-risk patients who are aged ≥65 y old or with comorbidities, an early surgical intervention was associated with a lower risk of complications (odds ratio: 0.77; 95% CI: 0.69-0.87; P < 0.001), and a lower mortality risk (odds ratio: 0.79; 95% CI: 0.68-0.92; P = 0.002). Patients with a delayed intervention were associated with a hospital stay >15 d (P < 0.001) and a higher cost of health services (P < 0.01).
  
  
  
  Patients treated in the Northeast of the United States were more likely to experience a delayed surgery. Delay of surgical intervention is associated with unfavorable outcomes only in older patients or those with comorbidities.
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Al-Qurayshi
authors.affiliation: Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Sudesh
authors.initials: S
authors.lastname: Srivastav
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana. Electronic address: ekandil@tulane.edu.
authors.forename: Emad
authors.initials: E
authors.lastname: Kandil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000706:statistics & numerical data*; D003108:Colonic Diseases / Q000401:mortality / Q000601:surgery*; D003125:Colostomy / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007416:Intestinal Perforation / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: Colon resection; Delayed intervention; Intestinal resection; Perforated bowel; Postoperative complication; Regional disparity