Adhesive small bowel obstruction in octogenarians: A 6-year retrospective single-center analysis of clinical management and outcomes

Abstract

Background: Few evidences are available on adhesive bowel obstruction (ASBO)management and outcomes in geriatric patients.

Methods: One-hundred-twenty-eight patients aged 65-79 years were retrospectively compared to 77 patients aged ≥80 years. Aim of this study was to compare ASBO management and in-hospital course between patients aged 65-79 years and those over 80 years.

Results: Upfront surgery in octogenarians related with a higher rate of major complications (23.7%vs4.9%; p = 0.009) and longer hospitalization (8.8vs7.3 days; p = 0.01). No difference according to age was noted in terms of clinical outcomes when the non-operative management (NOM) was employed. Patients aged ≥80 years managed conservatively presented shorter hospitalization (7.3vs8.8 days; p = 0.04), lower rate of intensive care unit (ICU)admission (0vs18.4%; p = 0.005) and cumulative major complications (2.6%vs23.7%; p = 0.007) as compared to ≥80 years old patients treated with upfront surgery. In this same group, NOM failure did not lead to worse outcomes in comparison to upfront surgery.

Conclusions: NOM in≥80 years patients is associated with better in-hospital course. The acceptable clinical outcomes in case of NOM failure further support NOM as first treatment strategy to employ in this same subset of patients.

Keywords: Adhesive small bowel obstruction; Octogenarians; Outcomes; elderly.