Incidence of intestinal obstruction due to post-surgical adhesions in the Central Military Hospital. Associated risk factors

Abstract

Introduction: Intestinal obstruction (IO) due to postoperative adhesions is an important cause of hospital admissions worldwide, with signifi cant morbidity and mortality that represent great costs for health systems worldwide. Objective: To estimate the incidence of intestinal obstruction due to postoperative adhesions and to identify risk factors in patients admitted to the General Surgery Service of the Central Military Hospital (CMH). Material and methods: The database of admitted patients to the CMH was revised from January 2009 to December 2013. Of the 14,769 surgeries performed, 393 patients presented intestinal obstruction. The demographic characteristics, type and number of previous surgeries and other risk factors for adhesions were identifi ed. Each patient was classified as IO by adhesions (IOA) or as IO associated with another pathology (IOP). Results: The overall incidence of post-surgical IO was 2.7%; 236 cases (1.6%) were secondary to surgical adhesions and the rest (1.1%) were associated with other pathology. Morbidity occurred in 8.5% of the IOA patients versus 13.5% of the IOP group (p = 0.118). Mortality was 6.4 versus 12.1%, respectively (p < 0.05). Laparotomy (34%), cholecystectomy (22%) and appendectomy (19%) were the surgeries most frequently associated with obstruction. Surgical treatment was done in 20% of the patients of the IOA group, versus 43% in the IOP group (p = 0.001). Risk factors associated to IOA were: female patients, number of previous abdominal surgeries and past admissions for intestinal obstruction. Conclusions: Intestinal obstruction syndrome due to post-surgical adhesions was the most common cause of IO from 2009 to 2013 in the Central Military Hospital. The incidence of this post-surgical adhesion syndrome is similar to that reported in world literature. Therapeutic decision oriented toward an initial conservative treatment should be correct. There were fewer hospitalization days and less mortality in the adhesion group treated without surgery.