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This too shall pass: Standardized Gastrografin protocol for partial small bowel obstruction
One of the most common reasons for admission to a surgical service is for a partial small bowel obstruction. There is considerable variation in management. Several studies suggest that the use of diatrizoate (Gastrografin), a hyperosmolar contrast agent, can be helpful as a diagnostic agent as well...
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| Published in: | The American journal of surgery 2019-06, Vol.217 (6), p.1016-1018 |
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| container_end_page | 1018 |
| container_issue | 6 |
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| container_title | The American journal of surgery |
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| creator | Long, S. Emigh, B. Wolf, J.S. Byrne, C. Coopwood, T.B. Aydelotte, J. |
| description | One of the most common reasons for admission to a surgical service is for a partial small bowel obstruction. There is considerable variation in management. Several studies suggest that the use of diatrizoate (Gastrografin), a hyperosmolar contrast agent, can be helpful as a diagnostic agent as well as possibly therapeutic, reducing the need for operative intervention. There is a paucity of data on the use of Gastrografin in the community setting. We hypothesized that this standardized algorithm of Gastrografin administration would decrease the need for surgery and shorten a patient's length of stay, even outside the confines of a regulated clinical trial.
We performed a retrospective review of all patients admitted to two major hospitals in our network with the diagnosis of partial small bowel obstruction. Patients were excluded if they were admitted within thirty days of bowel surgery or if they were |
| doi_str_mv | 10.1016/j.amjsurg.2018.12.063 |
| format | article |
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We performed a retrospective review of all patients admitted to two major hospitals in our network with the diagnosis of partial small bowel obstruction. Patients were excluded if they were admitted within thirty days of bowel surgery or if they were <18 years of age. The primary variable for analysis was the subsets of patients who were placed on our protocol versus no protocol at the other hospital. The primary outcome was hospital length of stay. Secondary outcomes included rate of surgery during the same admission and readmission within 30 days of discharge. All analyses were performed using Fisher's Exact test of Mann-Whitney U Test, as appropriate.
A total of 1302 patients with partial small bowel obstruction were identified (103 on-protocol and 1199 off-protocol at our sister hospital). On-protocol patients had a shorter duration of hospitalization (mean, 4.9 days vs. 6.0 days, p < 0.001), lower rates of surgery (2% vs. 16%, p < 0.001), and similar rates of readmission for the same diagnosis (8% and 5%, p = 0.26), compared to off-protocol patients at our sister institution.
A protocol utilizing Gastrografin for the management of partial small bowel obstruction decreases the need for surgery and shortens a patient's length of stay in a diverse community setting.
•One of the most common reasons for admission to a surgical service is for management of a small bowel obstruction.•There is considerable variation in the management of patients who present with a partial small bowel obstruction secondary to adhesive disease.•Gastrografin, a hyperosmolar contrast agent, is a useful agent in both the diagnosis and treatment of a partial small bowel obstruction.•A standardized protocol of Gastrografin administration decreases the need for surgery and shortens a patient's hospital length of stay.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2018.12.063</identifier><identifier>PMID: 30621907</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Abdomen ; Adhesives ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Algorithms ; Clinical Protocols ; Communities ; Contrast agents ; Contrast Media ; Diagnosis ; Diagnostic systems ; Diatrizoate Meglumine - therapeutic use ; Female ; Gastrointestinal Agents - therapeutic use ; Hospitals ; Humans ; Intervention ; Intestinal obstruction ; Intestinal Obstruction - diagnostic imaging ; Intestinal Obstruction - drug therapy ; Intestinal Obstruction - surgery ; Intestine, Small - diagnostic imaging ; Intestine, Small - surgery ; Length of Stay - statistics & numerical data ; Male ; Middle Aged ; Osmotic pressure ; Patients ; Physicians ; Retrospective Studies ; Small intestine ; Surgeons ; Surgery ; Treatment Outcome ; Young Adult</subject><ispartof>The American journal of surgery, 2019-06, Vol.217 (6), p.1016-1018</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><rights>2019. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-a31e02b3c9bf9c066c4faae30e763b5972412fcc686658681273143f9ca99a113</citedby><cites>FETCH-LOGICAL-c393t-a31e02b3c9bf9c066c4faae30e763b5972412fcc686658681273143f9ca99a113</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30621907$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Long, S.</creatorcontrib><creatorcontrib>Emigh, B.</creatorcontrib><creatorcontrib>Wolf, J.S.</creatorcontrib><creatorcontrib>Byrne, C.</creatorcontrib><creatorcontrib>Coopwood, T.B.</creatorcontrib><creatorcontrib>Aydelotte, J.</creatorcontrib><title>This too shall pass: Standardized Gastrografin protocol for partial small bowel obstruction</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>One of the most common reasons for admission to a surgical service is for a partial small bowel obstruction. There is considerable variation in management. Several studies suggest that the use of diatrizoate (Gastrografin), a hyperosmolar contrast agent, can be helpful as a diagnostic agent as well as possibly therapeutic, reducing the need for operative intervention. There is a paucity of data on the use of Gastrografin in the community setting. We hypothesized that this standardized algorithm of Gastrografin administration would decrease the need for surgery and shorten a patient's length of stay, even outside the confines of a regulated clinical trial.
We performed a retrospective review of all patients admitted to two major hospitals in our network with the diagnosis of partial small bowel obstruction. Patients were excluded if they were admitted within thirty days of bowel surgery or if they were <18 years of age. The primary variable for analysis was the subsets of patients who were placed on our protocol versus no protocol at the other hospital. The primary outcome was hospital length of stay. Secondary outcomes included rate of surgery during the same admission and readmission within 30 days of discharge. All analyses were performed using Fisher's Exact test of Mann-Whitney U Test, as appropriate.
A total of 1302 patients with partial small bowel obstruction were identified (103 on-protocol and 1199 off-protocol at our sister hospital). On-protocol patients had a shorter duration of hospitalization (mean, 4.9 days vs. 6.0 days, p < 0.001), lower rates of surgery (2% vs. 16%, p < 0.001), and similar rates of readmission for the same diagnosis (8% and 5%, p = 0.26), compared to off-protocol patients at our sister institution.
A protocol utilizing Gastrografin for the management of partial small bowel obstruction decreases the need for surgery and shortens a patient's length of stay in a diverse community setting.
•One of the most common reasons for admission to a surgical service is for management of a small bowel obstruction.•There is considerable variation in the management of patients who present with a partial small bowel obstruction secondary to adhesive disease.•Gastrografin, a hyperosmolar contrast agent, is a useful agent in both the diagnosis and treatment of a partial small bowel obstruction.•A standardized protocol of Gastrografin administration decreases the need for surgery and shortens a patient's hospital length of stay.</description><subject>Abdomen</subject><subject>Adhesives</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Algorithms</subject><subject>Clinical Protocols</subject><subject>Communities</subject><subject>Contrast agents</subject><subject>Contrast Media</subject><subject>Diagnosis</subject><subject>Diagnostic systems</subject><subject>Diatrizoate Meglumine - therapeutic use</subject><subject>Female</subject><subject>Gastrointestinal Agents - therapeutic use</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intervention</subject><subject>Intestinal obstruction</subject><subject>Intestinal Obstruction - diagnostic imaging</subject><subject>Intestinal Obstruction - drug therapy</subject><subject>Intestinal Obstruction - surgery</subject><subject>Intestine, Small - diagnostic imaging</subject><subject>Intestine, Small - surgery</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Osmotic pressure</subject><subject>Patients</subject><subject>Physicians</subject><subject>Retrospective Studies</subject><subject>Small intestine</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNqFkMtKxDAUhoMoOl4eQQm4cdOak8ykjRuRwRsILtSVi5Cmqaa0zZikij69GWZ04cbV4cD3n8uH0CGQHAjw0zZXfRtG_5JTAmUONCecbaAJlIXIoCzZJpoQQmgmOJAdtBtCm1qAKdtGO4xwCoIUE_T8-GoDjs7h8Kq6Di9UCGf4IaqhVr62X6bG1ypE7168auyAF95Fp12HG-cT7KNVHQ79Mlq5D9NhVyV61NG6YR9tNaoL5mBd99DT1eXj_Ca7u7--nV_cZZoJFjPFwBBaMS2qRmjCuZ42ShlGTMFZNRMFnQJttOYl57OSl0ALlt5IrBJCAbA9dLKam457G02IsrdBm65Tg3FjkBT4bJnkJKHHf9DWjX5I10lKkxXCOCsTNVtR2rsQvGnkwtte-U8JRC7ty1au7culfQlUJvspd7SePla9qX9TP7oTcL4CTNLxbo2XQVszaFNbb3SUtbP_rPgG9SiYcA</recordid><startdate>201906</startdate><enddate>201906</enddate><creator>Long, S.</creator><creator>Emigh, B.</creator><creator>Wolf, J.S.</creator><creator>Byrne, C.</creator><creator>Coopwood, T.B.</creator><creator>Aydelotte, J.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>201906</creationdate><title>This too shall pass: Standardized Gastrografin protocol for partial small bowel obstruction</title><author>Long, S. ; 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There is considerable variation in management. Several studies suggest that the use of diatrizoate (Gastrografin), a hyperosmolar contrast agent, can be helpful as a diagnostic agent as well as possibly therapeutic, reducing the need for operative intervention. There is a paucity of data on the use of Gastrografin in the community setting. We hypothesized that this standardized algorithm of Gastrografin administration would decrease the need for surgery and shorten a patient's length of stay, even outside the confines of a regulated clinical trial.
We performed a retrospective review of all patients admitted to two major hospitals in our network with the diagnosis of partial small bowel obstruction. Patients were excluded if they were admitted within thirty days of bowel surgery or if they were <18 years of age. The primary variable for analysis was the subsets of patients who were placed on our protocol versus no protocol at the other hospital. The primary outcome was hospital length of stay. Secondary outcomes included rate of surgery during the same admission and readmission within 30 days of discharge. All analyses were performed using Fisher's Exact test of Mann-Whitney U Test, as appropriate.
A total of 1302 patients with partial small bowel obstruction were identified (103 on-protocol and 1199 off-protocol at our sister hospital). On-protocol patients had a shorter duration of hospitalization (mean, 4.9 days vs. 6.0 days, p < 0.001), lower rates of surgery (2% vs. 16%, p < 0.001), and similar rates of readmission for the same diagnosis (8% and 5%, p = 0.26), compared to off-protocol patients at our sister institution.
A protocol utilizing Gastrografin for the management of partial small bowel obstruction decreases the need for surgery and shortens a patient's length of stay in a diverse community setting.
•One of the most common reasons for admission to a surgical service is for management of a small bowel obstruction.•There is considerable variation in the management of patients who present with a partial small bowel obstruction secondary to adhesive disease.•Gastrografin, a hyperosmolar contrast agent, is a useful agent in both the diagnosis and treatment of a partial small bowel obstruction.•A standardized protocol of Gastrografin administration decreases the need for surgery and shortens a patient's hospital length of stay.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30621907</pmid><doi>10.1016/j.amjsurg.2018.12.063</doi><tpages>3</tpages></addata></record> |
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| subjects | Abdomen Adhesives Adolescent Adult Aged Aged, 80 and over Algorithms Clinical Protocols Communities Contrast agents Contrast Media Diagnosis Diagnostic systems Diatrizoate Meglumine - therapeutic use Female Gastrointestinal Agents - therapeutic use Hospitals Humans Intervention Intestinal obstruction Intestinal Obstruction - diagnostic imaging Intestinal Obstruction - drug therapy Intestinal Obstruction - surgery Intestine, Small - diagnostic imaging Intestine, Small - surgery Length of Stay - statistics & numerical data Male Middle Aged Osmotic pressure Patients Physicians Retrospective Studies Small intestine Surgeons Surgery Treatment Outcome Young Adult |
| title | This too shall pass: Standardized Gastrografin protocol for partial small bowel obstruction |
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