Surgical treatment of mechanical bowel obstruction: characteristics and outcomes of geriatric patients compared to a younger cohort

Abstract

Purpose Mechanical bowel obstruction (MBO) is one of the most common indications for emergency surgery. Recent research justifies the method of attempting 3–5 days of nonoperative treatment before surgery. However, little is known about specific characteristics of geriatric patients undergoing surgery compared to a younger cohort. We aimed to analyze patients with MBO that required surgery, depending on their age, to identify potential targets for use in the reduction in complications and mortality in the elderly. Methods Thirty-day and in-hospital mortality were determined as primary outcome. We retrospectively identified all patients who underwent surgery for MBO at the University Hospital of Bonn between 2009 and 2019 and divided them into non-geriatric (40–74 years, n = 224) and geriatric (≥ 75 years, n = 88) patients, using the chi-squared-test and Mann–Whitney U test for statistical analysis. Results We found that geriatric patients had higher 30-day and in-hospital mortality rates than non-geriatric patients. As secondary outcome, we found that they experienced a longer length of stay (LOS) and higher complication rates than non-geriatric patients. Geriatric patients who suffered from large bowel obstruction (LBO) had a higher rate of bowel resection, stoma creation, and a higher 30-day mortality rate. The time from admission to surgery was not shown to be crucial for the outcome of (geriatric) patients. Conclusion Geriatric patients suffering from mechanical bowel obstruction that had to undergo surgery had higher mortality and morbidity than non-geriatric patients. Especially in regard to geriatric patients, clinicians should treat patients in a risk-adapted rather than time-adapted manner, and conditions should be optimized before surgery.

The Angers CT Score is a Risk Factor for the Failure of the Conservative Management of Adhesive Small Bowel Obstruction: A Prospective Observational Multicentric Study

“…Indeed, recent literature points out that unsuccessful conservative management is associated with an increased cost of management [10] and with an increased postoperative morbidity in cases in which secondary surgery is required [11, 12]. Focus must also be placed on elderly patients who suffer from higher morbimortality after aSBO surgery than younger patients in cases of failure of conservative management [13]. One way to reduce operative morbimortality is to proceed to laparoscopic surgery [2, 14, 15], which has a better feasibility if it is performed early [16].…”

“…• Jean-Marc Regimbeau 10,11 • Thierry Yzet 12 • Arnaud Alves 13,14 • Audrey Fohlen 15 • Damien Bergeat…”

Clinical case of acute intestinal objection caused by a foreign body

“…There is a high level of postoperative mortality in AIO, ranging from 3 to 25 %, due to unresolved longterm postoperative paresis of the small intestine, which contributes to the development of enteric syndrome, failure of intestinal anastomoses, translocation of bacterial flora into the abdomen. Therefore, AIO of various genesis remains one of the complex and urgent problems of emergency surgery [3][4][5]. The reasons for the unsatisfactory results of treatment of such patients are their late medical treatment and the vast majority of patients with this pathology of the elderly and senile.…”