World Journal of Surgery

, Volume 42, Issue 11, pp 3581–3588 | Cite as

Application of the AAST EGS Grade for Adhesive Small Bowel Obstruction to a Multi-national Patient Population

  • Matthew C. HernandezEmail author
  • Arianna Birindelli
  • John L. Bruce
  • Johannes J. P. Buitendag
  • Victory Y. Kong
  • Mircea Beuran
  • Johnathon M. Aho
  • Ionut Negoi
  • Damian L. Clarke
  • Salomone Di Saverio
  • Martin D. Zielinski
Original Scientific Report



The American Association for the Surgery of Trauma (AAST) anatomic severity grading system for adhesive small bowel obstruction (ASBO) has demonstrated to be a valid tool in North American patient populations. Using a multi-national patient cohort, we retrospectively assessed the validity the AAST ASBO grading system and estimated disease severity in a global population in order to correlate with several key clinical outcomes.


Multicenter retrospective review during 2012–2016 from four centers, Minnesota USA, Bologna Italy, Pietermaritzburg South Africa, and Bucharest Romania, was performed. Adult patients (age ≥ 18) with ASBO were identified. Baseline demographics, physiologic parameters, laboratory results, operative and imaging details, outcomes were collected. AAST ASBO grades were assigned by independent reviewers. Univariate and multivariable analyses with odds ratio (OR) and 95% confidence intervals (CIs) were performed.


There were 789 patients with a median [IQR] age of 58 [40–75] years; 47% were female. The AAST ASBO grades were I (n = 180, 23%), II (n = 443, 56%), III (n = 87, 11%), and IV (n = 79, 10%). Successful non-operative management was 58%. Conversion rate from laparoscopy to laparotomy was 33%. Overall mortality and complication and temporary abdominal closure rates were 2, 46, and 4.7%, respectively. On regression, independent predictors for mortality included grade III (OR 4.4 95%CI 1.1–7.3), grade IV (OR 7.4 95%CI 1.7–9.4), pneumonia (OR 5.6 95%CI 1.4–11.3), and failing non-operative management (OR 2.4 95%CI 1.3–6.7).


The AAST EGS grade can be assigned with ease at any surgical facility using operative or imaging findings. The AAST ASBO severity grading system has predictive validity for important clinical outcomes and allows for standardization across institutions, providers, and future research. Disease severity and outcomes varied between countries.

Level of evidence III

Study type Retrospective multi-institutional cohort study.


Authors’ contributions

MCH, AB, JLB, JJPB, VYK, MB, JMA, IN, DLC, SDS, MDZ all provided substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data as well as drafting/revision of the article for critically important intellectual content. All authors have provided final approval of this version of the manuscript.

Compliance with ethical standards

Conflict of interests

The authors declare no conflicts of interests.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Matthew C. Hernandez
    • 1
    Email author
  • Arianna Birindelli
    • 2
    • 3
  • John L. Bruce
    • 4
  • Johannes J. P. Buitendag
    • 4
  • Victory Y. Kong
    • 4
  • Mircea Beuran
    • 5
  • Johnathon M. Aho
    • 1
  • Ionut Negoi
    • 5
  • Damian L. Clarke
    • 4
  • Salomone Di Saverio
    • 2
    • 3
    • 6
  • Martin D. Zielinski
    • 1
  1. 1.Division of Trauma, Critical Care and General Surgery, Department of SurgeryMayo ClinicRochesterUSA
  2. 2.Department of SurgeryMaggiore HospitalBolognaItaly
  3. 3.Department of Surgery, NHSQueen Elizabeth University HospitalBirminghamUK
  4. 4.University of KwaZulu Natal, Department of Surgery, Pietermaritzburg Metropolitan ComplexPietermaritzburgSouth Africa
  5. 5.Department of General Surgery, Emergency Hospital of BucharestCarol Davila University of Medicine and Pharmacy of BucharestBucharestRomania
  6. 6.Addenbrookes Hospital, Cambridge University Hospitals, NHSUniversity of CambridgeCambridgeUK

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