Objective: The purpose of this study was to evaluate the impact of the timing of small bowel resection in small bowel injury on patients' outcomes.
Methods: This study was performed using data from patients included in the National Trauma Data Bank (2007-2010) who sustained blunt injuries and underwent a small bowel resection (SBR) within 24 h of arrival to the hospital. The patients' characteristics and outcomes were compared between two groups: SBR within 4 h (Group 1) and SBR between 4 and 24 h (Group 2) using Chi-square, Fisher exact, and Wilcoxon rank-sum tests. However, in an attempt to better balance the groups, propensity score matching was performed using baseline characteristics and a follow-up paired analysis was performed using McNemar, Stuart-Maxwell, and Wilcoxon signed-rank tests.
Results: A total of 1774 patients qualified for the study. Of those, 1,292 (72.8%) patients underwent SBR within 4 h and 482 (27.2%) underwent SBR between 4 and 24 h after arrival. There were significant baseline differences between the two groups regarding Injury Severity Score (ISS) [Median (IQR)19 (10, 29) vs 14 (9, 25), P < 0.001], Glasgow Coma Scale (GCS) [15 (13, 15) vs 15 (15, 15), P < 0.001] and the proportion of patients with an initial systolic blood pressure (SBP) < 90 mmHg (18.3% vs 8.7%, P < 0.001). Given these clear differences, 482 patients from each group were pair-matched using propensity score matching on age, sex, race, ISS, GCS, and SBP. After matching, there were no significant differences observed in the matching variables, patient mortality rate (8.3% vs 7.9%, P = 0.90), or discharge disposition (home with no services: 63.1% vs 64.9%, P = 0.90); however, there was a significantly shorter hospital length of stay for those patients in Group 1 compared to Group 2 [9 (6, 15) vs 10 (7, 19), P = 0.03].
Conclusion: More than 70% of the patient cases examined underwent SBR within 4 h of hospital arrival. However, there were no significant differences identified in the mortality rate or the discharge disposition regardless of the timing of the SBR (≤ 4 vs > 4-24 h). However, the patients whose SBR was performed within 4 h of arrival had a lower hospital length of stay when compared with those whose procedure was delayed.
Keywords: Blunt trauma; Mortality; Small bowel injury; Timing of small bowel resection.