Premium
GS22P
PROTOCOLS FOR MANAGEMENT OF BOWEL OBSTRUCTION MAY NOT IMPROVE PATIENT OUTCOMES
Author(s) -
Mignanelli E.,
Skinner S.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04119_22.x
Subject(s) - medicine , bowel obstruction , protocol (science) , prospective cohort study , surgery , pathology , alternative medicine
Purpose Bowel obstruction is a common surgical presentation, but has no defined management protocol. Our aim was to devise a series of protocols for small bowel obstruction (SBO) and large bowel obstruction (LBO) and determine if protocol implementation affects patient outcomes. Methods This prospective single‐blinded study involved an initial Medline literature review to develop “ideal management protocols” for both SBO and LBO. Patients with bowel obstruction were identified at admission and assigned to a treatment protocol. Treating clinicians were blinded to the protocols and managed patients as they normally would. Patients were followed prospectively with investigations and management compared to “ideal management protocol”. Results were evaluated using Students’ T‐Test and T test. Results Sixty consecutive patients were identified. The use of nasogastric tubes (65%) was lower than expected from the “ideal protocol”, but their use did not significantly impact on time to first bowel action (p = 0.48), length of stay (p = 0.19), time to surgery (p = 0.16). Urinary catheters were used in 70% of patients, but had no significant impact on renal function (p = 0.27). In adhesive SBO, Gastrograffin follow – through was used in 61.5% of cases, but did not impact on time to first bowel action (p = 0.13), length of stay (p = 0.08), time to surgery (p = 0.48). In LBO contrast enema was performed in only 30.1% of cases, but there was no significant delay in surgery (p = 0.98). Conclusion Current management of SBO and LBO varied widely from the “ideal management protocol”, yet patients managed outside the protocols showed no significant differences in overall outcomes.