LAKE BUENA VISTA, FLA. – A novel three-item scoring system reliably categorizes severity of small bowel obstruction and is more strongly associated with in-hospital mortality than the American Association for the Surgery of Trauma anatomic score alone.
The AAST developed a scoring system to standardize the severity of small-bowel obstruction (SBO) based on anatomic criteria. Its authors have subsequently recommended, however, that other parametersare needed that would take into consideration the entirety of the patient’s clinical situation (J. Trauma Acute Care Surg. 2014;77:705-8 and J. Trauma Acute Care Surg. 2014;76:884-7).
To that end, investigators at the Mayo Clinic in Rochester, Minn., created the Acute General Emergency Surgical Severity-Small Bowel Obstruction (AGESS-SBO) system that incorporates presenting physiology and pre-existing comorbidities with anatomic criteria.
“It’s evident that the complications and patient outcomes clearly depend on the extent of the involvement of the diseased organ, but also depend on the hosting environment, which means the patient’s physiology and pre-existing conditions,” Dr. Yaser Baghdadi explained at the annual scientific assembly of the Eastern Association for the Surgery of Trauma.
He reported a cohort study involving 377 patients who were treated for SBO at the Mayo Clinic between 2009 and 2012 and evaluated using anatomic criteria and the AGESS-SBO, which uses a 5-point scoring system for each of its three scales.
Most patients (57%) received a score of 1 on the AGESS-SBO anatomic involvement scale for a partial SBO without need of operation, while only 1% had a score of 5, indicating strangulation and perforation with diffuse peritoneal contamination.
On the physiology scale, 58.6% had no physiologic derangement or a score of 0, 36% had a score of 1 because of systemic inflammatory response syndrome, and only 1.1% had a score of 5 for multiple organ dysfunction syndrome.
A Charlson comorbid score of 1 or 2 earned 32% of patients 1 point on the comorbidity scale, while 4% had a score of 5 because of a Charlson score of 9 or more.
In all, 215 patients (57%) had nonoperative treatment and 162 patients (43%) underwent surgical exploration. The median overall AGESS-SBO score was 6 points (interquartile range [IQR], 3-13 points).
The median length of stay (LOS) was 5 days (IQR, 3-9.5 days), with 94 patients (25%) having a stay exceeding 9.5 days, Dr. Baghdadi said in the poster presentation. In-hospital complications occurred in 82 patients (22%) and eight patients (2%) died during their hospital stay.
Comparison of the areas under receiver operative characteristic curves revealed a statistically significant greater association between the AGESS-SBO score and in-hospital mortality than the AAST anatomic score (AUC, 0.79 vs. 0.55, P value = .015), reported Dr. Baghdadi, a research fellow in the Mayo Clinic’s trauma division.
The two scoring systems had comparable ability to predict in-hospital complications (AUC, 0.72 vs. 0.69; P = .42) and extended LOS (AUC, 0.72 vs. 0.74; P = .47). The lack of statistical significance favoring the AGESS-SBO may be because these outcomes would be more likely in patients requiring surgery and the analysis combined patients who did and did not require operative care, he said in an interview.
“The AGESS-SBO system is a useful tool to classify the disease severity among SBO patients compared to the AAST anatomic score alone. We are planning to run a prospective study to validate what we have found,” he added.
Dr. Baghdadi and his coauthors reported having no financial disclosures.