Can the Laparoscopic Approach for Adhesive Small Bowel Obstruction be Used in Octogenarians? An Observational Study Using ACS NSQIP

J Surg Res. 2019 Jan;233:345-350. doi: 10.1016/j.jss.2018.07.064. Epub 2018 Sep 7.

Abstract

Background: With the population of octogenarians projected to increase fourfold by 2050, we sought to compare outcomes of laparoscopic versus open approach in octogenarians requiring surgery for adhesive small bowel obstruction (SBO).

Methods/materials and methods: Using 2006-2015 American College of Surgeons National Surgical Quality Improvement Project, we identified patients aged ≥80 y who underwent emergency surgery within 1 d of admission for SBO. Risk variables of interest included age, sex, race, body mass index, preoperative sepsis, and American Society of Anesthesiologists (ASA) classification. Outcomes included length of stay, mortality, and pneumonia. Univariable and multivariable analyses were performed.

Results: Eight hundred fifty-six patients were identified. Six hundred ninety-nine (81.7%) underwent laparotomy; 157 (18.3%) underwent laparoscopy. Twenty-four (15.3%) of laparoscopic cases were converted. There was no difference between the open and laparoscopic groups in age, and race, preoperative albumin, or preoperative sepsis. The open group had higher rates of totally dependent functional status, congestive heart failure, chronic obstructive pulmonary disease, and higher ASA class. There was no difference in operative time. Laparoscopy was associated with shorter length of stay. The open approach showed higher rates of postoperative pneumonia, myocardial infarct, and mortality. Multivariable analysis showed increased age, functional status, preoperative albumin, and ASA class associated with mortality. The operative approach was not associated with mortality. Postoperative pneumonia was associated with male sex and open approach.

Conclusions: Age, preoperative functional status, low preoperative albumin, and ASA classes IV and V were associated with mortality, while the open approach and male sex were associated with postoperative pneumonia. Octogenarians who present with SBO due to adhesive disease may benefit from an initial laparoscopic exploration. Further prospective studies are warranted.

Keywords: Acute care surgery; Adhesive disease; Comparison study; Elderly; Emergency surgery; Exploratory laparotomy; Laparoscopic surgery; Lysis of adhesions; Octogenarian; Small bowel obstruction.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Age Factors
  • Aged, 80 and over
  • Conversion to Open Surgery / statistics & numerical data
  • Databases, Factual / statistics & numerical data
  • Female
  • Health Status*
  • Hospital Mortality
  • Humans
  • Intestinal Obstruction / mortality
  • Intestinal Obstruction / surgery*
  • Intestine, Small / surgery
  • Laparoscopy / adverse effects*
  • Laparoscopy / methods
  • Length of Stay / statistics & numerical data
  • Male
  • Operative Time
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Sex Factors
  • Tissue Adhesions / mortality
  • Tissue Adhesions / surgery
  • Treatment Outcome
  • United States / epidemiology