Background: The American Association for the Surgery of Trauma (AAST) anatomic severity grading system for adhesive small bowel obstruction (ASBO) has demonstrated to be a valid tool in North American patient populations. Using a multi-national patient cohort, we retrospectively assessed the validity the AAST ASBO grading system and estimated disease severity in a global population in order to correlate with several key clinical outcomes.
Methods: Multicenter retrospective review during 2012-2016 from four centers, Minnesota USA, Bologna Italy, Pietermaritzburg South Africa, and Bucharest Romania, was performed. Adult patients (age ≥ 18) with ASBO were identified. Baseline demographics, physiologic parameters, laboratory results, operative and imaging details, outcomes were collected. AAST ASBO grades were assigned by independent reviewers. Univariate and multivariable analyses with odds ratio (OR) and 95% confidence intervals (CIs) were performed.
Results: There were 789 patients with a median [IQR] age of 58 [40-75] years; 47% were female. The AAST ASBO grades were I (n = 180, 23%), II (n = 443, 56%), III (n = 87, 11%), and IV (n = 79, 10%). Successful non-operative management was 58%. Conversion rate from laparoscopy to laparotomy was 33%. Overall mortality and complication and temporary abdominal closure rates were 2, 46, and 4.7%, respectively. On regression, independent predictors for mortality included grade III (OR 4.4 95%CI 1.1-7.3), grade IV (OR 7.4 95%CI 1.7-9.4), pneumonia (OR 5.6 95%CI 1.4-11.3), and failing non-operative management (OR 2.4 95%CI 1.3-6.7).
Conclusion: The AAST EGS grade can be assigned with ease at any surgical facility using operative or imaging findings. The AAST ASBO severity grading system has predictive validity for important clinical outcomes and allows for standardization across institutions, providers, and future research. Disease severity and outcomes varied between countries.
Level Of Evidence Iii: Study type Retrospective multi-institutional cohort study.
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Background: Adhesive small bowel obstruction (ASBO) severity has been associated with important clinical outcomes. However, the impact of ASBO severity on hospitalization cost is unknown. The American Association for the Surgery of Trauma (AAST) developed an Emergency General Surgery (EGS) disease severity grading system for ASBO.
View Article and Find Full Text PDFApplication of the AAST EGS Grade for Adhesive Small Bowel Obstruction to a Multi-national Patient Population.
World J Surg
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Division of Trauma, Critical Care and General Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Background: The American Association for the Surgery of Trauma (AAST) anatomic severity grading system for adhesive small bowel obstruction (ASBO) has demonstrated to be a valid tool in North American patient populations. Using a multi-national patient cohort, we retrospectively assessed the validity the AAST ASBO grading system and estimated disease severity in a global population in order to correlate with several key clinical outcomes.
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The American Association for the Surgery of Trauma Severity Grade is valid and generalizable in adhesive small bowel obstruction.
J Trauma Acute Care Surg
February 2018
From the Division of Trauma Critical Care and General Surgery, Department of Surgery (M.C.H., N.N.H., M.D.Z., A.C.), Mayo Clinic, Rochester, Minnesota; Department of Surgery (D.C.C.), Marshfield Clinic, Marshfield, Wisconsin; Division of Trauma, Department of Surgery (D.T., J-M.Y.), Loma Linda University, Loma Linda, California; Division of Trauma Surgery, Department of Surgery (S.W.), Cooper University Hospital, New Jersey; Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery (K.I.), University of Southern California, Los Angeles, California; Department of Surgery (D.D.Y.), Massachusetts General Hospital, Boston, Massachusetts; Division of Trauma Surgery, Department of Surgery (T.M.D.), John Peter Smith, Fort Worth, Texas; Department of Surgery (A.P.), Kern Medical Center, Baekrsfield, California; Division of Trauma, Department of Surgery (J.W.), Inova Fairfax Hospital, Annandale, Virginia; Division of Trauma, Department of Surgery (C.J.R.), Water Reed National Military Medical Center, Bethesda, Maryland; Department of Surgery (K.A.W.), Geisinger Medical Center, Danville, Pennsylvania; Department of Surgery (J.C.), Greenville Memorial Hospital, Greenville, South Carolina; Department of Surgery (J.D.), UC Health Northern Colorado, Fort Collins, Colorado; Department of Surgery (E.A.T.), East Carolina University, Greenville, North Carolina; and Department of Surgery (J.C.G.), San Antonio Military Medical Center, San Antonio, Texas.
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Methods: Adults (age ≥ 18) with (ASBO) were included.
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