Predicting the outcome of closed-loop small bowel obstruction by preoperative characteristics

Table 1 Baseline characteristics of patients in the three study groups

Baseline characteristics	Total, n = 148	Viable bowel, n = 28	Reversible ischemia, n = 86	Irreversible ischemia, n = 34	P value
Male, n (%)	64 (43.24)	13 (46.43)	41 (47.67)	10 (29.41)	0.18
Age in yr, median (range)	68 (15–98)	57 (35–98)	68 (15–93)	76 (23–92)	0.04
ASA classification (%)					0.01
1–2	82 (55.41)	18 (64.29)	53 (61.63)	11 (32.35)
≥ 3	66 (44.59)	10 (35.71)	33 (38.37)	23 (67.65)
BMI in kg/m2, median (range)	24 (16–35)	23 (17–31)	24 (16–35)	23 (18–30)	0.89
Previous abdominal surgery, median (%)	86 (58.11)	19 (67.86)	45 (52.33)	22 (64.71)	0.24

ASA: American Society of Anaesthesiologists; BMI: Body mass index.

Table 2 Logistic regression of predictors of perioperative ischemia

Patient characteristics	Viable bowel, OR (95%CI)	Reversible ischemia, OR (95%CI)	Irreversible ischemia, OR (95%CI)
Age	Ref.	1.01 (0.98-1.03)	1.03 (0.99-1.06)
ASA classification
1-2	Ref.	Ref.	Ref.
≥ 3	Ref.	1.12 (0.46–2.72)	3.76 (1.31-10.81)

ASA: American Society of Anaesthesiologists; CI: Confidence interval; OR: Odds ratio.

Table 3 Clinical symptoms and vital signs at presentation

Signs at presentation	Overall, n = 148	Viable bowel, n = 28	Reversible ischemia, n = 82	Irreversible ischemia, n = 34	P value
Vomiting, n (%)					0.07
No	36 (24.32)	9 (32.14)	15 (17.44)	12 (35.29)
Yes	112 (75.68)	19 (67.86)	71 (82.56)	22 (64.71)
Obstipation1, n (%)					0.60
No	105 (70.95)	22 (78.57)	60 (69.77)	23 (67.65)
Yes	43 (29.05)	6 (21.43)	26 (30.23)	11 (32.35)
Abdominal guarding, n (%)					0.35
No	133 (89.86)	27 (96.43)	77 (89.53)	29 (85.29)
Yes	15 (10.14)	1 (3.57)	9 (10.47)	5 (14.71)
Heart rate2, n (%)					0.42
Bradycardia	2 (1.35)	0 (0.00)	1 (1.16)	1 (2.94)
Normocardia	120 (81.08)	26 (92.86)	67 (77.91)	27 (79.41)
Tachycardia	26 (17.67)	2 (7.14)	18 (20.93)	6 (17.65)
Respiratory rate3,4, n (%)					0.50
Normopnoea	45 (60.00)	9 (69.23)	27 (64.29)	9 (45.00)
Tachypnea	30 (40.00)	4 (30.77)	15 (35.71)	11 (55.00)
Fever5, n (%)					0.52
No	138 (97.18)	25 (96.15)	79 (96.34)	34 (100.00)
Yes	4 (2.82)	1 (3.85)	3 (3.66)	0 (0.00)

¹Obstipation: No defecation > 24 h.

²Bradycardia: ≤ 50 beats/min; Normocardia: 50-100 beats/min; Tachycardia: > 100 beats/min.

³Normopnoea: < 20 breaths/min; Tachypnoea: > 20 breaths/min.

⁴11 patients missing, n = 137.

⁵Fever: > 38.5 °C body temperature.

Table 4 Patient characteristics and findings of perioperative ischemia

Infection parameters at presentation	Overall, n = 148	Viable bowel, n = 28	Reversible ischemia, n = 86	Irreversible ischemia, n = 34	P value
WBC, median (%)
4.5-11 × 109/L	48 (32.43)	9 (32.14)	31 (36.05)	8 (23.53)	0.42
> 11 × 109/L	100 (67.57)	19 (67.86)	55 (63.95)	26 (76.47)
CRP, median (%)					0.92
1–10 mg/L	82 (55.10)	15 (53.57)	49 (56.47)	18 (52.94)
11–74 mg/L	38 (25.85)	7 (25.00)	23 (27.06)	8 (23.53)
> 75 mg/L	28 (19.05)	6 (21.43)	14 (16.47)	8 (23.53)

CRP: C-reactive protein; WBC: White blood cell.

Table 5 Blood and laboratory results in the three study groups

Laboratory results at presentation	Overall, median (range)	Viable bowel, median (range)	Reversible ischemia, median (range)	Irreversible ischemia, median (range)	P value
Haematocrit, L/L	0.43 (0.31-0.59)	0.43 (0.37-0.52)	0.44 (0.34-0.59)	0.42 (0.31-0.53)	0.34
Thrombocytes × 109/L	263.00 (145.00-687.00)	280.50 (161.00-687.00)	266.00 (145.00-650.00)	235.50 (148.00-511.00)	0.20
WBCs × 109/L	11.80 (4.0-27.2)	12.40 (4.80-21.30)	11.55 (4.00-25.00)	12.00 (5.50-27.20)	0.33
CRP, mg/L	6.00 (1.00-630.00)	6.00 (1.00-216.00)	5.50 (1.00-630.00)	5.00 (1.00-434.00)	0.84
Creatinine, μmol/L	80.00 (38.00-785.00)	81.00 (53.00-141.00)	80.00 (38.00-785.00)	81.00 (45.00-258.00)	0.97
Urea, mmol/L	6.60 (2.30-30.60)	5.95 (2.70-23.10)	6.40 (2.30-30.60)	7.60 (3.00-20.70)	0.33
LDH, U/L	208.00 (109.00-333.00)	184.00 (142.00-309.00)	210.00 (109.00-309.00)	208.00 (151.00-333.00)	0.15
CK, U/L	112.00 (24.00-472.00)	107.50 (30.00-207.00)	127.50 (51.00-472.00)	95.00 (24.00-192.00)	0.47
Albumin, g/L	44.00 (36.00-52.00)	43.00 (36.00-50.00)	44.00 (37.00-52.00)	40.50 (37.00-51.00)	0.10
Glucose, mmol/L	8.00 (5.00-15.60)	7.40 (5.40-12.20)	8.00 (5.00-15.60)	8.20 (5.10-15.00)	0.19

CK: Creatine kinase; CRP: C-reactive protein; LDH: Lactate dehydrogenase; WBC: White blood cell.

Table 6 Suspicion of ischemia on computed tomography imaging in the three study groups

Grading of initial radiology reports	Viable bowel, n = 28	Reversible ischemia, n = 86	Irreversible ischemia, n = 34
No suspicion of ischemia, n (%)	18 (64.29)	23 (26.74)	4 (11.76)
Inconclusive, n (%)	10 (36.71)	51 (59.30)	17 (50.00)
Strong suspicion of ischemia, n (%)	0	12 (13.96)	13 (38.24)

Table 7 Intervals between onset of symptoms and computed tomography and surgery in the three study groups

Intervals	Viable bowel, n = 28	Reversible ischemia, n = 86	Irreversible ischemia, n = 34	P value
Onset of symptoms to CT, median (range)	16.50 h (2.00–120.00 h)	20.50 h (1.00–260.00 h)	18.00 h (2.00–120.00 h)	0.79
CT to surgery, median (range)	4.00 h (1.00–65.00 h)	4.00 h (1.00–51.00 h)	4.00 h (1.00–71.00 h)	0.98
Onset of symptoms to surgery, median (range)	23.00 h (3.00–124.00 h)	26.00 h (2.00–264.00 h)	25.50 h (5.00–126.00 h)	0.91

CT: Computed tomography.

Table 8 Clavien–Dindo classification of complications and perioperative findings

Clavien–Dindo	Overall, n = 148	Viable bowel, n = 28	Reversible ischaemia, n = 86	Irreversible ischaemia, n = 34
No complications, n (%)	115 (77.70)	27 (96.43)	69 (80.23)	19 (55.88)
Grade I, n (%)	3 (2.03)	0 (0.00)	2 (2.33)	1 (2.94)
Grade II, n (%)	7 (4.73)	0 (0.00)	3 (3.49)	4 (11.76)
Grade III, n (%)
a	1 (0.68)	0 (0.00)	1 (1.16)	0 (0.00)
b	10 (6.76)	1 (3.57)	3 (3.49)	6 (17.65)
Grade IV, n (%)
a	1 (0.68)	0 (0.00)	1 (1.16)	0 (0.00)
b	1 (0.68)	0 (0.00)	0 (0.00)	1 (2.94)
Grade V, n (%)	10 (6.76)	0 (0.00)	7 (8.14)	3 (8.82)

Grade I: Complication without pharmacological, surgical, endoscopic, or radiologic treatment (anti-emetics, antipyretics, analgesics, diuretics, electrolytes and physiotherapy were acceptable); Grade II: Complication requiring pharmacological management including blood transfusion or total parenteral nutrition; Grade IIIa: Complication requiring intervention under local anaesthesia; Grade IIIb: Complication requiring general or epidural anaesthesia; Grade IVa: Single organ dysfunction (including dialysis); Grade IVb: Multiorgan dysfunction; Grade V: Patient death.