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01-11-2018 | Original Scientific Report

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

Authors: Matthew C. Hernandez, 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

Published in: World Journal of Surgery | Issue 11/2018

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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Title: Application of the AAST EGS Grade for Adhesive Small Bowel Obstruction to a Multi-national Patient Population
Authors: Matthew C. Hernandez
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
Publication date: 01-11-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 11/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4671-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

Level of evidence III

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Level of evidence III

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