Hospital Volume of Emergency General Surgery and its Impact on Inpatient Mortality for Geriatric Patients: Analysis From 3994 Hospitals

Background Previous investigations have shown a positive association between hospital volume of operations and clinical outcomes. However, it is unclear whether such relationships also apply to emergency surgery. We sought to examine the association between hospital case volume and inpatient mortality for 7 common emergency general surgery (EGS) operations among geriatric patients. Methods This is a population based retrospective cohort study using the Centers of Medicare and Medicaid Services (CMS) Limited Dataset Files (LDS) from 2011 to 2013. The 7 most common emergency surgeries included (1) partial colectomy, (2) small-bowel resection (SBR), (3) cholecystectomy, (4) appendectomy, (5) lysis of adhesions (LOA), (6) operative management of peptic ulcer disease (PUD), and (7) laparotomy with the primary outcome being inpatient mortality. Risk-adjusted inpatient mortality was plotted against operative volume. Subsequently an operative volume threshold was calculated using a best fit regression method. Based on these estimates, high- and low-volume hospitals were compared to examine significance of outcomes. Significance was defined as P-value < .05. Results The final cohort comprised of 414 779 patients from 3994 hospitals. The standardized mortality ratio (SMR) for high-volume centers were lower in 6 out of 8 surgeries examined. Small-bowel resection and partial colectomy operations had a significant decrease in mortality based on a volume threshold. Conclusion We observed decreased mortality with higher surgical volume for small-bowel resection and partial colectomy operations. Such differences may be related to practice patterns during the perioperative period, as complications related to the perioperative care were significantly lower for high-volume centers.

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Modified Paul-Mikulicz jejunostomy in frail geriatric patients undergoing emergency small bowel resection

Minerva Chirurgica ◽

10.23736/s0026-4733.18.07714-3 ◽

2019 ◽

Vol 74 (2) ◽

Author(s):

Paolo Ruscelli ◽

Georgi Popivanov ◽

Renata Tabola ◽

Andrea Polistena ◽

Alessandro Sanguinetti ◽

...

Keyword(s):

Small Bowel ◽

Geriatric Patients ◽

Bowel Resection ◽

Small Bowel Resection

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EP.FRI.9Meta-analysis of mortality risk in octogenarians undergoing emergency General Surgery operations

British Journal of Surgery ◽

10.1093/bjs/znab312.003 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Shahab Hajibandeh ◽

Shahin Hajibandeh ◽

George A Antoniou ◽

Stavros A Antoniou

Keyword(s):

Mortality Risk ◽

General Surgery ◽

Bowel Resection ◽

Small Bowel Resection ◽

Outcome Data ◽

Colon Resection ◽

Emergency Laparotomy ◽

Emergency General Surgery ◽

Random Effects Models ◽

Surgical Operations

Abstract Aims To quantify the risk of perioperative mortality in octogenarians undergoing emergency general surgical operations and to compare such risk between octogenarians and non-octogenarians. Methods A systematic review was performed in accordance with the PRISMA statement standards to identify studies reporting the mortality risk in patients aged over 80 years undergoing emergency general surgery operations. The certainty of evidence was assessed using the GRADE system. Random-effects models were applied to calculate pooled outcome data. Results Analysis of 66701 octogenarians from 22 studies showed that the risk of 30-day mortality was 26% (95% CI 18-34%) for all operations;29% (95% CI 25-33%) for emergency laparotomy,9% (95% CI 1-23%) for non-laparotomy emergency operations;21% (95% CI 13-30%) for colon resection;17% (95% CI 11-25%) for small bowel resection;9% (95% CI 7-11%) for adhesiolysis;6% (95% CI 5.9-6.8%) for perforated ulcer repair;3% (95% CI 2.6-4%) for appendicectomy;3% (95% CI 2.8-3.3%) for cholecystectomy;5% (95% CI 0.2-14%) for hernia repair. When stratified based on ASA status, the risk was 11% (95% CI 4-20%) for ASA 2, 22% (95% CI 10-36%) for ASA 3, 39% (95% CI 29-48%) for ASA 4, and 94% (95% CI 77-100%) for ASA 5. The risk was higher in octogenarians compared with non-octogenarians (OR:4.07,95% CI 2.40-6.89), patients aged 70-79 (OR:1.21,95% CI 1.13-1.31), and patients aged 50-79 (OR:2.03,95% CI 1.68-2.45). Conclusions The risk of perioperative death in octogenarians undergoing emergency general surgical operations is higher than the risk in younger patients. Laparotomy, bowel resection, and ASA status above 3 carry the highest risk.

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Relation of Small Bowel Resection to Nutrition in Man

Gastroenterology ◽

10.1016/s0016-5085(60)80035-2 ◽

1960 ◽

Vol 38 (4) ◽

pp. 605-615 ◽

Cited By ~ 36

Author(s):

M.H. Kalser ◽

J.L.A. Roth ◽

H. Tumen ◽

T.A. Johnson

Keyword(s):

Small Bowel ◽

Bowel Resection ◽

Small Bowel Resection

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The effect of pre-resection obesity on post-resection body composition after 75% small bowel resection in rats

Scientific Reports ◽

10.1038/s41598-021-92510-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Neesha S. Patel ◽

Ujwal R. Yanala ◽

Shruthishree Aravind ◽

Roger D. Reidelberger ◽

Jon S. Thompson ◽

...

Keyword(s):

Body Weight ◽

Small Bowel ◽

Lean Mass ◽

Bowel Resection ◽

Small Bowel Resection ◽

High Fat ◽

Low Fat ◽

Low Fat Diet ◽

Massive Resection ◽

Obese Rats

AbstractIn patients with short bowel syndrome, an elevated pre-resection Body Mass Index may be protective of post-resection body composition. We hypothesized that rats with diet-induced obesity would lose less lean body mass after undergoing massive small bowel resection compared to non-obese rats. Rats (CD IGS; age = 2 mo; N = 80) were randomly assigned to either a high-fat (obese rats) or a low-fat diet (non-obese rats), and fed ad lib for six months. Each diet group then was randomized to either underwent a 75% distal small bowel resection (massive resection) or small bowel transection with re-anastomosis (sham resection). All rats then were fed ad lib with an intermediate-fat diet (25% of total calories) for two months. Body weight and quantitative magnetic resonance-determined body composition were monitored. Preoperative body weight was 884 ± 95 versus 741 ± 75 g, and preoperative percent body fat was 35.8 ± 3.9 versus 24.9 ± 4.6%; high-fat vs. low fat diet, respectively (p < 0.0001); preoperative diet type had no effect on lean mass. Regarding total body weight, massive resection produced an 18% versus 5% decrease in high-fat versus low-fat rats respectively, while sham resection produced a 2% decrease vs. a 7% increase, respectively (p < 0.0001, preoperative vs. necropsy data). Sham resection had no effect on lean mass; after massive resection, both high-fat and low-fat rats lost lean mass, but these changes were not different between the latter two rat groups. The high-fat diet and low-fat diet induced obesity and marginal obesity, respectively. The massive resection produced greater weight loss in high-fat rats compared to low-fat rats. The type of dietary preconditioning had no effect on lean mass loss after massive resection. A protective effect of pre-existing obesity on lean mass after massive intestinal resection was not demonstrated.

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Pituitary hormones and the small bowel: effect of hypophysectomy on intestinal adaptation to small bowel resection in the rat

European Journal of Clinical Investigation ◽

10.1111/j.1365-2362.1979.tb01677.x ◽

1979 ◽

Vol 9 (2) ◽

pp. 115-127 ◽

Cited By ~ 26

Author(s):

BRYCE TAYLOR ◽

GERARD M. MURPHY ◽

R. HERMON DOWLING

Keyword(s):

Small Bowel ◽

Bowel Resection ◽

Intestinal Adaptation ◽

Small Bowel Resection ◽

Pituitary Hormones

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Pathophysiological correlates of two unique renal tubule lesions in rats with intestinal resection

AJP Renal Physiology ◽

10.1152/ajprenal.00033.2006 ◽

2006 ◽

Vol 291 (5) ◽

pp. F1061-F1069 ◽

Cited By ~ 7

Author(s):

Elaine Worcester ◽

Andrew Evan ◽

Sharon Bledsoe ◽

Mark Lyon ◽

Mark Chuang ◽

...

Keyword(s):

Calcium Phosphate ◽

Small Bowel ◽

Bowel Resection ◽

Cell Damage ◽

Intestinal Resection ◽

Small Bowel Resection ◽

Renal Tissue ◽

Apical Surface ◽

Crystal Deposition ◽

Oxalate Excretion

Rats with small bowel resection fed a high-oxalate diet develop extensive deposition of calcium oxalate (CaOx) and calcium phosphate crystals in the kidney after 4 mo. To explore the earliest sites of renal crystal deposition, rats received either small bowel resection or transection and were then fed either standard chow or a high-oxalate diet; perfusion-fixed renal tissue from five rats in each group was examined by light microscopy at 2, 4, 8, and 12 wk. Rats fed the high-oxalate diet developed birefringent microcrystals at the brush border of proximal tubule cells, with or without cell damage; the lesion was most common in rats with both resection and a high-oxalate diet (10/19 with the lesion) and was significantly correlated with urine oxalate excretion ( P < 0.001). Rats with bowel resection fed normal chow had mild hyperoxaluria but high urine CaOx supersaturation; four of these rats developed birefringent crystal deposition with tubule plugging in inner medullary collecting ducts (IMCD). Two rats fed a high-oxalate diet also developed this lesion, which was correlated with CaOx supersaturation, but not oxalate excretion. Tissue was examined under oil immersion, and tiny birefringent crystals were noted on the apical surface of IMCD cells only in animals with IMCD crystal plugging. In one animal, IMCD crystals were both birefringent and nonbirefringent, suggesting a mix of CaOx and calcium phosphate. Overall, these animals demonstrate two distinct sites and mechanisms of renal crystal deposition and may help elucidate renal lesions seen in humans with enteric hyperoxaluria and stones.

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Cocaine-induced mesenteric ischaemia requiring small bowel resection

BMJ Case Reports ◽

10.1136/bcr-2020-238593 ◽

2021 ◽

Vol 14 (1) ◽

pp. e238593

Author(s):

Asya Veloso Costa ◽

Asiya Zhunus ◽

Rehana Hafeez ◽

Arsh Gupta

Keyword(s):

Small Bowel ◽

Social History ◽

Bowel Resection ◽

Early Recognition ◽

Small Bowel Resection ◽

Emergency Laparotomy ◽

Mesenteric Ischaemia ◽

Bowel Ischaemia ◽

Systemic Complications ◽

Gastrointestinal Complications

Cocaine use causes profound vasoconstriction leading to various systemic complications. Gastrointestinal complications such as mesenteric ischaemia are difficult to recognise and may result in serious consequences if not treated promptly. We report on the case of a 47-year-old man presenting with mesenteric ischaemia on a background of acute on chronic cocaine consumption, where diagnosis was not evident until second presentation. He underwent an emergency laparotomy with small bowel resection and jejunostomy formation and made a good recovery with eventual reversal surgery. The literature on cocaine-induced bowel ischaemia shows significant variability in presentation and outcome. Laboratory investigations are non-specific, and early recognition is vital. Given the increasing recreational use of cocaine in the UK, it is imperative to have a high clinical index of suspicion for mesenteric ischaemia in patients presenting with non-specific abdominal pain, and to ensure a detailed social history covering recreational drug use is not forgotten.

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