TY - JOUR
T1 - Adhesive small bowel obstruction in elderly patients: a single-center analysis of treatment strategies and clinical outcomes
AU - Quero, Giuseppe
AU - Covino, Marcello
AU - Laterza, Vito
AU - Fiorillo, Claudio
AU - Rosa, Fausto
AU - Menghi, Roberta
AU - Fransvea, Pietro
AU - Cozza, Valerio
AU - Sganga, Gabriele
AU - Franceschi, Francesco
AU - Alfieri, Sergio
PY - 2021
Y1 - 2021
N2 - Introduction The incidence of adhesive bowel obstruction (ASBO) progressively increases with age. Strong evidences on the influencing role of age on ASBO clinical course and management are still lacking. Aim of this study is to retrospectively analyze the clinical outcomes of patients older than 65 years of age admitted to a tertiary referral Emergency Department with a diagnosis of ASBO. Materials and methods We reviewed the clinical records of patients admitted for ASBO in the period 2014-2019. Patients were divided in elderly (>= 65 years) and non-elderly (<65 years). Primary endpoint was to compare the all-cause in-hospital mortality and the occurrence of major complications in the two groups. Secondary endpoint was a comparison of clinical presentation, clinical course and management. Results We enrolled 285 elderly and 492 non-elderly patients. Vomit was more frequent in the elderly (51.9% vs 34.6%; p < .001), while no difference was evidenced for the remaining symptoms of ASBO presentation. A higher rate of non-operative management (NOM) (26.3% vs 16.5%; p = .010), ICU admission (16% vs 0.6%; p < .001), mortality (2.1% vs 0.2%; p = .007) and cumulative major complications (8.8% vs 3.3%; p = .001), as well as a prolonged hospitalization (8.2 vs 5.4 days; p < .001) was evidenced in the >= 65 years group. Multivariate analysis identified increasing age (OR:2.8; 95%CI:1.09-7.2; p = .040) and Charlson comorbidity index >= 2 (OR:2.5; 95% CI:1.2-6.4; p = .050) as the only independent predictors of cumulative major complications. Conclusions Despite the similarity in terms of clinical presentation, elderly patient present higher mortality rate and occurrence of major complications. A comprehensive geriatric assessment is recommended to optimize the diagnostic and clinical strategies in case of ASBO.
AB - Introduction The incidence of adhesive bowel obstruction (ASBO) progressively increases with age. Strong evidences on the influencing role of age on ASBO clinical course and management are still lacking. Aim of this study is to retrospectively analyze the clinical outcomes of patients older than 65 years of age admitted to a tertiary referral Emergency Department with a diagnosis of ASBO. Materials and methods We reviewed the clinical records of patients admitted for ASBO in the period 2014-2019. Patients were divided in elderly (>= 65 years) and non-elderly (<65 years). Primary endpoint was to compare the all-cause in-hospital mortality and the occurrence of major complications in the two groups. Secondary endpoint was a comparison of clinical presentation, clinical course and management. Results We enrolled 285 elderly and 492 non-elderly patients. Vomit was more frequent in the elderly (51.9% vs 34.6%; p < .001), while no difference was evidenced for the remaining symptoms of ASBO presentation. A higher rate of non-operative management (NOM) (26.3% vs 16.5%; p = .010), ICU admission (16% vs 0.6%; p < .001), mortality (2.1% vs 0.2%; p = .007) and cumulative major complications (8.8% vs 3.3%; p = .001), as well as a prolonged hospitalization (8.2 vs 5.4 days; p < .001) was evidenced in the >= 65 years group. Multivariate analysis identified increasing age (OR:2.8; 95%CI:1.09-7.2; p = .040) and Charlson comorbidity index >= 2 (OR:2.5; 95% CI:1.2-6.4; p = .050) as the only independent predictors of cumulative major complications. Conclusions Despite the similarity in terms of clinical presentation, elderly patient present higher mortality rate and occurrence of major complications. A comprehensive geriatric assessment is recommended to optimize the diagnostic and clinical strategies in case of ASBO.
KW - Adhesive bowel obstruction
KW - advanced age
KW - elderly
KW - geriatric assessment
KW - outcomes
KW - Adhesive bowel obstruction
KW - advanced age
KW - elderly
KW - geriatric assessment
KW - outcomes
UR - http://hdl.handle.net/10807/248214
U2 - 10.1080/00365521.2021.1921256
DO - 10.1080/00365521.2021.1921256
M3 - Article
SN - 0036-5521
VL - 56
SP - 784
EP - 790
JO - Scandinavian Journal of Gastroenterology
JF - Scandinavian Journal of Gastroenterology
ER -