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

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Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

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References

  1. Ellis H, Moran BJ, Thompson JN et al (1999) Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 353(9163):1476–1480. https://doi.org/10.1016/s0140-6736(98)09337-4

    Article  CAS  PubMed  Google Scholar 

  2. Majewski WD (2005) Long-term outcome, adhesions, and quality of life after laparoscopic and open surgical therapies for acute abdomen: follow-up of a prospective trial. Surg Endosc Other Interv Tech. 19(1):81–90. https://doi.org/10.1007/s00464-003-9333-0

    Article  CAS  Google Scholar 

  3. Lower AM, Hawthorn RJS, Clark D et al (2004) Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24 046 patients. Hum Reprod 19(8):1877–1885. https://doi.org/10.1093/humrep/deh321

    Article  CAS  PubMed  Google Scholar 

  4. Scott JW, Olufajo OA, Brat GA et al (2016) Use of national burden to define operative emergency general surgery. JAMA Surg 2115(6):e160480. https://doi.org/10.1001/jamasurg.2016.0480

    Article  Google Scholar 

  5. Jeppesen MH, Tolstrup M-B, Kehlet Watt S, Gögenur I (2016) Risk factors affecting morbidity and mortality following emergency laparotomy for small bowel obstruction: a retrospective cohort study. Int J Surg. 28:63–68. https://doi.org/10.1016/j.ijsu.2016.02.059

    Article  PubMed  Google Scholar 

  6. Krielen P, van den Beukel BA, Stommel MWJ, van Goor H, Strik C, ten Broek RPG (2016) In-hospital costs of an admission for adhesive small bowel obstruction. World J Emerg Surg. 11(1):1–8. https://doi.org/10.1186/s13017-016-0109-y

    Article  Google Scholar 

  7. Zielinski MD, Haddad NN, Cullinane DC et al (2017) Multi-institutional, prospective, observational study comparing the Gastrografin challenge versus standard treatment in adhesive small bowel obstruction. J Trauma Acute Care Surg. 83(1):47–54. https://doi.org/10.1097/TA.0000000000001499

    Article  PubMed  Google Scholar 

  8. Zielinski MD, Eiken PW, Bannon MP et al (2010) Small bowel obstruction-Who needs an operation? A multivariate prediction model. World J Surg 34(5):910–919. https://doi.org/10.1007/s00268-010-0479-3

    Article  PubMed  PubMed Central  Google Scholar 

  9. Zielinski MD, Eiken PW, Heller SF et al (2011) Prospective, observational validation of a multivariate small-bowel obstruction model to predict the need for operative intervention. J Am Coll Surg 212(6):1068–1076. https://doi.org/10.1016/j.jamcollsurg.2011.02.023

    Article  PubMed  Google Scholar 

  10. Bollen TL, Singh VK, Maurer R et al (2012) A comparative evaluation of radiologic and clinical scoring systems in the early prediction of severity in acute pancreatitis. Am J Gastroenterol 107(4):612–619. https://doi.org/10.1038/ajg.2011.438

    Article  PubMed  Google Scholar 

  11. Jancelewicz T, Vu LT, Shawo AE, Yeh B, Gasper WJ, Harris HW (2009) Predicting strangulated small bowel obstruction: an old problem revisited. J Gastrointest Surg. 13(1):93–99. https://doi.org/10.1007/s11605-008-0610-z

    Article  PubMed  Google Scholar 

  12. Millet I, Boutot D, Faget C et al (2017) Assessment of strangulation in adhesive small bowel obstruction on the basis of combined Ct findings: implications for clinical care. Radiology. https://doi.org/10.1148/radiol.2017162352

    Article  PubMed  Google Scholar 

  13. Shafi S, Aboutanos M, Brown CV-R et al (2014) Measuring anatomic severity of disease in emergency general surgery. J Trauma Acute Care Surg 76(3):884–887. https://doi.org/10.1097/TA.0b013e3182aafdba

    Article  PubMed  Google Scholar 

  14. Utter GH, Miller PR, Mowery NT et al (2015) ICD-9-CM and ICD-10-CM mapping of the AAST emergency general surgery disease severity grading systems: conceptual approach, limitations, and recommendations for the future. J Trauma Acute Care Surg 78(5):1059–1065. https://doi.org/10.1097/TA.0000000000000608

    Article  PubMed  Google Scholar 

  15. Tominaga GT, Staudenmayer KL, Shafi S et al (2016) The American association for the surgery of trauma grading scale for 16 emergency general surgery conditions. J Trauma Acute Care Surg 81(3):1. https://doi.org/10.1097/TA.0000000000001127

    Article  Google Scholar 

  16. Crandall ML, Agarwal S, Muskat P et al (2014) Application of a uniform anatomic grading system to measure disease severity in eight emergency general surgical illnesses. J Trauma Acute Care Surg 77(5):705–708. https://doi.org/10.1097/TA.0000000000000444

    Article  PubMed  Google Scholar 

  17. Baghdadi YMK, Morris DS, Choudhry AJ et al (2016) Validation of the anatomic severity score developed by the American Association for the Surgery of Trauma in small bowel obstruction. J Surg Res 204(2):428–434. https://doi.org/10.1016/j.jss.2016.04.076

    Article  PubMed  Google Scholar 

  18. Calderale SM, Sandru R, Tugnoli G et al (2008) Comparison of quality control for trauma management between western and eastern European trauma center. World J Emerg Surg 3(1):1–9. https://doi.org/10.1186/1749-7922-3-32

    Article  Google Scholar 

  19. Branco BC, Barmparas G, Schnüriger B, Inaba K, Chan LS, Demetriades D (2010) Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction. Br J Surg 97(4):470–478. https://doi.org/10.1002/bjs.7019

    Article  CAS  PubMed  Google Scholar 

  20. Zielinski MD, Haddad NN, Choudhry A et al (2017) The American Association for the Surgery of Trauma Severity Grade is valid and generalizable in adhesive small bowel obstruction. J Trauma Acute Care Surg. https://doi.org/10.1097/ta.0000000000001736

    Article  PubMed  PubMed Central  Google Scholar 

  21. LA Mentula PJ (2014) Applicability of the Clavien–Dindo classification to emergency surgical procedures: a retrospective cohort study on 444 consecutive patients. Patient Saf Surg 8(1):1–7. https://doi.org/10.1186/1754-9493-8-31

    Article  Google Scholar 

  22. ten Broek RPG, Issa Y, van Santbrink EJP et al (2013) Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ 347:f5588. https://doi.org/10.1136/bmj.f5588

    Article  PubMed  PubMed Central  Google Scholar 

  23. ten Broek RPG, Strik C, Issa Y, Bleichrodt RP, van Goor H (2013) Adhesiolysis-related morbidity in abdominal surgery. Ann Surg 258(1):98–106. https://doi.org/10.1097/SLA.0b013e31826f4969

    Article  PubMed  Google Scholar 

  24. Coccolini F, Ansaloni L, Manfredi R et al (2013) Peritoneal adhesion index (PAI): proposal of a score for the “ignored iceberg” of medicine and surgery. World J Emerg Surg 8(1):6. https://doi.org/10.1186/1749-7922-8-6

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kulvatunyou N, Pandit V, Moutamn S et al (2015) A multi-institution prospective observational study of small bowel obstruction. J Trauma Acute Care Surg 79(3):393–398. https://doi.org/10.1097/TA.0000000000000759

    Article  PubMed  Google Scholar 

  26. Matsushima K, Inaba K, Dollbaum R et al (2016) High-density free fluid on computed tomography: a predictor of surgical intervention in patients with adhesive small bowel obstruction. J Gastrointest Surg 20(11):1861–1866. https://doi.org/10.1007/s11605-016-3244-6

    Article  PubMed  Google Scholar 

  27. Jones K, Mangram AJ, Lebron RA, Nadalo L, Dunn E (2007) Can a computed tomography scoring system predict the need for surgery in small-bowel obstruction? Am J Surg 194(6):780–784. https://doi.org/10.1016/j.amjsurg.2007.09.020

    Article  PubMed  Google Scholar 

  28. Zielinski MD, Bannon MP (2011) Current management of small bowel obstruction. Adv Surg 45(1):1–29. https://doi.org/10.1016/j.yasu.2011.03.017

    Article  PubMed  Google Scholar 

  29. O’Connor DB, Winter DC (2012) The role of laparoscopy in the management of acute small-bowel obstruction: a review of over 2,000 cases. Surg Endosc Other Interv Tech. 26(1):12–17. https://doi.org/10.1007/s00464-011-1885-9

    Article  Google Scholar 

  30. Teixeira PG, Karamanos E, Talving P, Inaba K, Lam L, Demetriades D (2013) Early operation is associated with a survival benefit for patients with adhesive bowel obstruction. Ann Surg 258(3):459–465. https://doi.org/10.1097/SLA.0b013e3182a1b100

    Article  PubMed  Google Scholar 

  31. Hernandez MC, Polites SF, Aho JM et al (2017) Measuring anatomic severity in pediatric appendicitis: validation of the American Association for the Surgery of Trauma appendicitis severity grade. J Pediatr. https://doi.org/10.1016/j.jpeds.2017.09.017

    Article  PubMed  Google Scholar 

  32. Hernandez M, Aho JM, Habermann EB, Choudhry A, Morris D, Zielinski M (2016) Increased anatomic severity predicts outcomes: validation of the American Association for the Surgery of Trauma’s emergency general surgery score in appendicitis. J Trauma Acute Care Surg. https://doi.org/10.1097/TA.0000000000001274

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Division of Trauma, Critical Care and General Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Matthew C. Hernandez, Johnathon M. Aho & Martin D. Zielinski

  2. Department of Surgery, Maggiore Hospital, Bologna, Italy

    Arianna Birindelli & Salomone Di Saverio

  3. Department of Surgery, NHS, Queen Elizabeth University Hospital, Birmingham, UK

    Arianna Birindelli & Salomone Di Saverio

  4. University of KwaZulu Natal, Department of Surgery, Pietermaritzburg Metropolitan Complex, Pietermaritzburg, South Africa

    John L. Bruce, Johannes J. P. Buitendag, Victory Y. Kong & Damian L. Clarke

  5. Department of General Surgery, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy of Bucharest, Bucharest, Romania

    Mircea Beuran & Ionut Negoi

  6. Addenbrookes Hospital, Cambridge University Hospitals, NHS, University of Cambridge, Cambridge, UK

    Salomone Di Saverio

Authors
  1. Matthew C. Hernandez
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  2. Arianna Birindelli
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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.

Corresponding author

Correspondence to Matthew C. Hernandez.

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The authors declare no conflicts of interests.

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Hernandez, M.C., Birindelli, A., Bruce, J.L. et al. Application of the AAST EGS Grade for Adhesive Small Bowel Obstruction to a Multi-national Patient Population. World J Surg 42, 3581–3588 (2018). https://doi.org/10.1007/s00268-018-4671-1

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  • DOI: https://doi.org/10.1007/s00268-018-4671-1

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