Use and Outcomes of Dexamethasone in the Management of Malignant Small Bowel Obstruction
Objective:. To describe rates of dexamethasone use in the nonoperative management of malignant small bowel obstruction (mSBO) and their outcomes. Background:. mSBO is common in patients with advanced abdominal-pelvic cancers. Management includes prioritizing quality of life and avoiding surgical int...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health
2024-06-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000431 |
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| author | Frank F. Yang, MD Elina Serrano, MD Kyle S. Bilodeau, MD Michael Weykamp, MD Caitlin J. Silvestri, MD Ashleigh C. M. Bull, MD Brenda Lin, MD Sara L. Schaefer, MD Colette Galet, PhD Luis J. Garcia, MD, FACS Baraka Gitonga, BS David T. Kolodziej, BS Samantha Esposito, BS Molly Parker-Brigham, BS Rohan Luhar, BS Avinash Mamgain, MS Kendrick C. Brown, BS Summer Dewdney, MD Thea P. Price, MD, FACS Nicole Siparsky, MD, FACS Sarah Knerr, PhD Pauline K. Park, MD, FACS Sabrina Sanchez, MD, FACS Dionne A. Skeete, MD, FACS Katherine N. Fischkoff, MD, FACS David R. Flum, MD, FACS |
| author_facet | Frank F. Yang, MD Elina Serrano, MD Kyle S. Bilodeau, MD Michael Weykamp, MD Caitlin J. Silvestri, MD Ashleigh C. M. Bull, MD Brenda Lin, MD Sara L. Schaefer, MD Colette Galet, PhD Luis J. Garcia, MD, FACS Baraka Gitonga, BS David T. Kolodziej, BS Samantha Esposito, BS Molly Parker-Brigham, BS Rohan Luhar, BS Avinash Mamgain, MS Kendrick C. Brown, BS Summer Dewdney, MD Thea P. Price, MD, FACS Nicole Siparsky, MD, FACS Sarah Knerr, PhD Pauline K. Park, MD, FACS Sabrina Sanchez, MD, FACS Dionne A. Skeete, MD, FACS Katherine N. Fischkoff, MD, FACS David R. Flum, MD, FACS |
| author_sort | Frank F. Yang, MD |
| collection | DOAJ |
| description | Objective:. To describe rates of dexamethasone use in the nonoperative management of malignant small bowel obstruction (mSBO) and their outcomes.
Background:. mSBO is common in patients with advanced abdominal-pelvic cancers. Management includes prioritizing quality of life and avoiding surgical intervention when possible. The use of dexamethasone to restore bowel function is recommended in the National Comprehensive Cancer Network guidelines for mSBO. Yet, it is unknown how often dexamethasone is used for mSBO and whether results from nonresearch settings support its use.
Methods:. This is a multicenter retrospective cohort study including unique admissions for mSBO from January 1, 2019 to December 31, 2021. Dexamethasone use and management outcomes were summarized with descriptive statistics and multiple logistic regression.
Results:. Among 571 admissions (68% female, mean age 63 years, 85% history of abdominal surgery) that were eligible and initially nonoperative, 26% [95% confidence interval (CI) = 23%–30%] received dexamethasone treatment (69% female, mean age 62 years, 87% history of abdominal surgery). Dexamethasone use by site ranged from 13% to 52%. Among dexamethasone recipients, 13% (95% CI = 9%–20%) subsequently required nonelective surgery during the same admission and 4 dexamethasone-related safety-events were reported. Amongst 421 eligible admissions where dexamethasone was not used, 17% (95% CI = 14%–21%) required nonelective surgery. Overall, the unadjusted odds ratio (OR) for nonelective surgery with dexamethasone use compared to without its use was 0.7 (95% CI = 0.4–1.3). Using multiple logistic regression, OR after adjusting for site, age, sex, history of abdominal surgery, nasogastric tube, and Gastrografin use was 0.6 (95% CI = 0.3–1.1).
Conclusion:. Dexamethasone was used in about 1 in 4 eligible mSBO admissions with high variability of use between tertiary academic centers. This multicenter retrospective cohort study suggested an association between dexamethasone use and lower rates of nonelective surgery, representing a potential opportunity for quality improvement. |
| format | Article |
| id | doaj-art-616ebf52d41341bb82d980ad710ae384 |
| institution | Kabale University |
| issn | 2691-3593 |
| language | English |
| publishDate | 2024-06-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj-art-616ebf52d41341bb82d980ad710ae3842025-01-24T09:18:39ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932024-06-0152e43110.1097/AS9.0000000000000431202406000-00029Use and Outcomes of Dexamethasone in the Management of Malignant Small Bowel ObstructionFrank F. Yang, MD0Elina Serrano, MD1Kyle S. Bilodeau, MD2Michael Weykamp, MD3Caitlin J. Silvestri, MD4Ashleigh C. M. Bull, MD5Brenda Lin, MD6Sara L. Schaefer, MD7Colette Galet, PhD8Luis J. Garcia, MD, FACS9Baraka Gitonga, BS10David T. Kolodziej, BS11Samantha Esposito, BS12Molly Parker-Brigham, BS13Rohan Luhar, BS14Avinash Mamgain, MS15Kendrick C. Brown, BS16Summer Dewdney, MD17Thea P. Price, MD, FACS18Nicole Siparsky, MD, FACS19Sarah Knerr, PhD20Pauline K. Park, MD, FACS21Sabrina Sanchez, MD, FACS22Dionne A. Skeete, MD, FACS23Katherine N. Fischkoff, MD, FACS24David R. Flum, MD, FACS25* From the Department of Surgery, University of Washington, Seattle, WA* From the Department of Surgery, University of Washington, Seattle, WA* From the Department of Surgery, University of Washington, Seattle, WA* From the Department of Surgery, University of Washington, Seattle, WA† Department of Surgery, Columbia University Irving Medical Center, New York, NY‡ Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA§ Department of Surgery, Boston University, Boston, MA‖ Department of Surgery, University of Michigan, Ann Arbor, MI‡ Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA‡ Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA* From the Department of Surgery, University of Washington, Seattle, WA‡ Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA¶ Department of Surgery, Rush University Medical Center, Chicago, IL¶ Department of Surgery, Rush University Medical Center, Chicago, IL¶ Department of Surgery, Rush University Medical Center, Chicago, IL¶ Department of Surgery, Rush University Medical Center, Chicago, IL¶ Department of Surgery, Rush University Medical Center, Chicago, IL¶ Department of Surgery, Rush University Medical Center, Chicago, IL¶ Department of Surgery, Rush University Medical Center, Chicago, IL¶ Department of Surgery, Rush University Medical Center, Chicago, IL# Department of Health Systems and Population Health, University of Washington, Seattle, WA.‖ Department of Surgery, University of Michigan, Ann Arbor, MI§ Department of Surgery, Boston University, Boston, MA‡ Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA† Department of Surgery, Columbia University Irving Medical Center, New York, NY* From the Department of Surgery, University of Washington, Seattle, WAObjective:. To describe rates of dexamethasone use in the nonoperative management of malignant small bowel obstruction (mSBO) and their outcomes. Background:. mSBO is common in patients with advanced abdominal-pelvic cancers. Management includes prioritizing quality of life and avoiding surgical intervention when possible. The use of dexamethasone to restore bowel function is recommended in the National Comprehensive Cancer Network guidelines for mSBO. Yet, it is unknown how often dexamethasone is used for mSBO and whether results from nonresearch settings support its use. Methods:. This is a multicenter retrospective cohort study including unique admissions for mSBO from January 1, 2019 to December 31, 2021. Dexamethasone use and management outcomes were summarized with descriptive statistics and multiple logistic regression. Results:. Among 571 admissions (68% female, mean age 63 years, 85% history of abdominal surgery) that were eligible and initially nonoperative, 26% [95% confidence interval (CI) = 23%–30%] received dexamethasone treatment (69% female, mean age 62 years, 87% history of abdominal surgery). Dexamethasone use by site ranged from 13% to 52%. Among dexamethasone recipients, 13% (95% CI = 9%–20%) subsequently required nonelective surgery during the same admission and 4 dexamethasone-related safety-events were reported. Amongst 421 eligible admissions where dexamethasone was not used, 17% (95% CI = 14%–21%) required nonelective surgery. Overall, the unadjusted odds ratio (OR) for nonelective surgery with dexamethasone use compared to without its use was 0.7 (95% CI = 0.4–1.3). Using multiple logistic regression, OR after adjusting for site, age, sex, history of abdominal surgery, nasogastric tube, and Gastrografin use was 0.6 (95% CI = 0.3–1.1). Conclusion:. Dexamethasone was used in about 1 in 4 eligible mSBO admissions with high variability of use between tertiary academic centers. This multicenter retrospective cohort study suggested an association between dexamethasone use and lower rates of nonelective surgery, representing a potential opportunity for quality improvement.http://journals.lww.com/10.1097/AS9.0000000000000431 |
| spellingShingle | Frank F. Yang, MD Elina Serrano, MD Kyle S. Bilodeau, MD Michael Weykamp, MD Caitlin J. Silvestri, MD Ashleigh C. M. Bull, MD Brenda Lin, MD Sara L. Schaefer, MD Colette Galet, PhD Luis J. Garcia, MD, FACS Baraka Gitonga, BS David T. Kolodziej, BS Samantha Esposito, BS Molly Parker-Brigham, BS Rohan Luhar, BS Avinash Mamgain, MS Kendrick C. Brown, BS Summer Dewdney, MD Thea P. Price, MD, FACS Nicole Siparsky, MD, FACS Sarah Knerr, PhD Pauline K. Park, MD, FACS Sabrina Sanchez, MD, FACS Dionne A. Skeete, MD, FACS Katherine N. Fischkoff, MD, FACS David R. Flum, MD, FACS Use and Outcomes of Dexamethasone in the Management of Malignant Small Bowel Obstruction Annals of Surgery Open |
| title | Use and Outcomes of Dexamethasone in the Management of Malignant Small Bowel Obstruction |
| title_full | Use and Outcomes of Dexamethasone in the Management of Malignant Small Bowel Obstruction |
| title_fullStr | Use and Outcomes of Dexamethasone in the Management of Malignant Small Bowel Obstruction |
| title_full_unstemmed | Use and Outcomes of Dexamethasone in the Management of Malignant Small Bowel Obstruction |
| title_short | Use and Outcomes of Dexamethasone in the Management of Malignant Small Bowel Obstruction |
| title_sort | use and outcomes of dexamethasone in the management of malignant small bowel obstruction |
| url | http://journals.lww.com/10.1097/AS9.0000000000000431 |
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