DOI: http://dx.doi.org/10.18203/2349-2902.isj20210916

A study on the trends and patterns of intestinal obstruction and surgical outcome based on APACHE score II in a tertiary care centre

Himangsu Sarma, Ashwinikumar Kudari

Abstract


Background: One of the most common intra-abdominal problems faced by general surgeons in their practice remains bowel obstruction. It is important to identify and analyse the clinical presentation and etiology of patients with acute intestinal obstruction. With its multiple etiologies, intestinal obstruction of either the small or large bowel continues to be a major cause of morbidity and mortality.

Methods: An observational study was carried out at Narayana Hrudayalaya Hospital, Bangalore between July 2016 and June 2019 involving 190 patients, after approval from Institutional ethics Committee. Predicted mortality rates were calculated using the APACHE II scoring system by linear analysis method. It was then compared with the actual outcomes. Univariate and multivariate analysis was carried to analyze the collected data.

Results: The commonest cause in this study was postoperative adhesions [82 patients (43.2%)]. Frequency of mortality in our study was 7.9%. ROC curve analysis to predict the mortality using APACHE score showed sensitivity (80%), specificity (81.14%) and AUROC=0.796. P value was <0.001 which is highly significant. A positive correlation was found between deaths and complications with higher APACHE scores.

Conclusions: Successful treatment of acute intestinal obstruction depends upon early diagnosis, skilful management and treating the pathological effects of the obstruction just as much as the cause itself. The APACHE II score allows for direct comparison between the observed and expected adverse outcome rates. They can also be used to determine prognosis and help family members make informed decisions about the aggressiveness of care.


Keywords


Adhesiolysis, CT scan, Gangrene bowel, Intestinal obstruction, Resection anastomosis

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References


Joseph EF, Michael SN. Manifestations of gastrointestinal disease. In: Principles of surgery. 7th edn. McGraw-Hill International Editions; 1999:1054-1061.

Tiwari SJ, Mulmule R, Bijwe VN. A clinical study of acute intestinal obstruction in adults-based on etiology, severity indicators and surgical outcome. Int J Res Med Sci. 2017;5:3688-96.

Norman SW, MCCaskie A, O’Connell PR, Jim H. Intestinal obstruction. In: Bailey and Love’s Short practice of surgery. 27th edn. CRC Press; 2018:1280-1298.

Jack RP, Josef EF. Small and large bowel obstruction. In: Fisher JE, Bland KI, eds. Mastery of surgery. 5th edn. Boston: Lipincott Williams and Wilkins; 2009:1380-1387.

Turnage RH, Heldmann M. Intestinal obstruction. In: Sleisenger MH, Feldman M, Friedman LS, Brandt LJ, eds. Sleisinger and Fordtran’s Gastrointestinal and Liver disease. 9th edn. Philadelphia : Saunders; 2010:2116-2117.

Margaret F, Brendon M. Operative management of small and large bowel disease. In: Farquharson’s Textbook of operative general surgery. 9th ed. Hodder Arnold (London); 2005:409.

Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med. 1981;9(8):591-7.

Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;100(6):1619-36.

Zimmerman JE, Kramer AA, McNair DS, Malila FM. Acute physiology and chronic health evaluation (APACHE) IV: Hospital mortality assessment for today's critically ill patients. Crit Care Med. 2006;34(5):1297-310.

Wang PG, Li H, Li SK, Jiang YJ, Gao P, Sui GD. Value of modified APACHE II score in predicting postoperative complications in patients with acute obstructing colorectal carcinoma; Zhonghua Wei Chang Wai Ke Za Zhi. 2011;14(4):257-60.

Nag DS, Dembla A, Mahanty PR, Kant S, Chatterjee A, Samaddar DP, et al. Comparative analysis of APACHE-II and P-POSSUM scoring systems in predicting postoperative mortality in patients undergoing emergency laparotomy. World J Clin Cases. 2019;7(16):2227.

Pillai V, Benjamin RK, Chisthi MM. A pattern of intestinal obstruction cases- a tertiary care centre study. Ann Int Med Den Res. 2017;3(2):SG41-5.

Chakma N, Sarkar B, Sarkar P. A retrospective study of intestinal obstruction patients in AGMC and GBP hospital. Tripura J Evol Med Dent Sci. 2016;5(103):7531-3.

Bernard R. Fundamentals of Biostatistics. 5th edn. Pacific Grove, CA: Duxbury; 2000:80-240.

Robert HR. Statistics in Medicine. 2nd edn. Academic Press; 2005:85-125.

Sunder R, Richard J. An introduction to biostatistics: a manual for students in health sciences. 4th edn. New Delhi: Prentice/Hall of India; 2006:86-160.

Suresh KP, Chandrasekhar S. Sample size estimation and power analysis for clinical research studies. J Hum Reprod Sci. 2012;5(1):7-13.

Souvik A, Mohammed ZH, Amitabha D, Nilenjan M, Udipta R. Etiology and outcome of acute intestinal obstruction: a review of 367 patients in Eastern India. Saudi J Gastroenterol. 2010;16(4):285-7.

Jahangir SK, Junaid A, Hamid H, Mohammed I. Pattern of intestinal obstruction a hospital based study. Pak Armed Forces Med J. 2007;4.

Koperna T, Semmler D, Marian F. Risk stratification in emergency surgical patients: is the APACHE II score a reliable marker of physiological impairment? Arch Surg. 2001;136(1):55-9.

Chen TM, Huang YT, Wang GC. Outcome of colon cancer initially presenting as colon perforation and obstruction. World J Surg Oncol. 2017;15(1):164.