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Examining the impact of small bowel resection procedure timing in patients with blunt traumatic injury: a propensity-matched analysis

  • Nasim AhmedEmail author
  • Patricia Greenberg
Original Article
  • 36 Downloads

Abstract

Objective

The purpose of this study was to evaluate the impact of the timing of small bowel resection in small bowel injury on patients’ outcomes.

Methods

This study was performed using data from patients included in the National Trauma Data Bank (2007–2010) who sustained blunt injuries and underwent a small bowel resection (SBR) within 24 h of arrival to the hospital. The patients’ characteristics and outcomes were compared between two groups: SBR within 4 h (Group 1) and SBR between 4 and 24 h (Group 2) using Chi-square, Fisher exact, and Wilcoxon rank-sum tests. However, in an attempt to better balance the groups, propensity score matching was performed using baseline characteristics and a follow-up paired analysis was performed using McNemar, Stuart-Maxwell, and Wilcoxon signed-rank tests.

Results

A total of 1774 patients qualified for the study. Of those, 1,292 (72.8%) patients underwent SBR within 4 h and 482 (27.2%) underwent SBR between 4 and 24 h after arrival. There were significant baseline differences between the two groups regarding Injury Severity Score (ISS) [Median (IQR)19 (10, 29) vs 14 (9, 25), P < 0.001], Glasgow Coma Scale (GCS) [15 (13, 15) vs 15 (15, 15), P < 0.001] and the proportion of patients with an initial systolic blood pressure (SBP) < 90 mmHg (18.3% vs 8.7%, P < 0.001). Given these clear differences, 482 patients from each group were pair-matched using propensity score matching on age, sex, race, ISS, GCS, and SBP. After matching, there were no significant differences observed in the matching variables, patient mortality rate (8.3% vs 7.9%, P = 0.90), or discharge disposition (home with no services: 63.1% vs 64.9%, P = 0.90); however, there was a significantly shorter hospital length of stay for those patients in Group 1 compared to Group 2 [9 (6, 15) vs 10 (7, 19), P = 0.03].

Conclusion

More than 70% of the patient cases examined underwent SBR within 4 h of hospital arrival. However, there were no significant differences identified in the mortality rate or the discharge disposition regardless of the timing of the SBR (≤ 4 vs > 4–24 h). However, the patients whose SBR was performed within 4 h of arrival had a lower hospital length of stay when compared with those whose procedure was delayed.

Keywords

Blunt trauma Small bowel injury Timing of small bowel resection Mortality 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures followed were in accordance with the ethical standards of the Institutional Review Board of Meridian Health and with the Helsinki Declaration of 1975, as revised in 2008. Since the study was done using a de-identified National database from the American College of Surgeons that is available to all researchers, this study was exempted from IRB review as per policy.

Informed consent

Given that this study was done using a de-identified National database from the American College of Surgeons that is available to all researchers, this study was exempted from IRB review as per policy and no informed consent was required.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Trauma and Surgical Critical Care, Department of SurgeryJersey Shore University Medical CenterNeptuneUSA
  2. 2.Department of Research AdministrationJersey Shore University Medical CenterNeptuneUSA

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