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Routine Nasogastric Decompression in Small Bowel Obstruction: Is It Really Necessary?
*Annabelle L Fonseca, *Kevin M Schuster, *Adrian A Maung, Lewis J Kaplan, *Felix Y Lui, Kimberly A Davis
Yale New Haven Hospital, New Haven, CT

To evaluate the role of nasogastric decompression in the management of patients with small bowel obstruction (SBO): Are nasogastric tubes (NGT) required, and do they benefit patients?
Case series. Comparisons using the student’s t-test, Chi-square, and multivariate logistic regression.
University tertiary referral center.
Two hundred and ninety adult patients presenting to the emergency department (January 2005 - December 2010) diagnosed with SBO identified by International Classification of Disease Codes (ICD-9).
Main Outcome Measures:
Outcomes included days to resolution, complications, and hospital length of stay (HLOS).
Of 290 patients 190 (65.52%) were managed non-operatively. Fifty-five patients (18.97%) did not have a NGT. Diabetes (OR 2.09, p=0.022) and lack of colonic air on CT scan (OR 1.20, p=0.011) were positive predictors while abdominal distension (OR 0.25, p=0.045) and tympany (OR 0.29, p=0.035) were negative predictors of NGT insertion. Gastric volumes on CT scan did not predict initial NGT drainage. Forty-nine of 68 patients without emesis had an NGT inserted. Pneumonia (OR 1.42, p=0.007) and respiratory failure (OR 1.41, p=0.013) were associated with NGT placement in non-operatively managed (non-op) patients. Time to resolution (2.97 days vs. 1.63, p<0.001) and HLOS (9.57 days vs. 3.13, p<0.001) were longer in non-op patients with NGTs. The relationship to pneumonia persisted (OR 1.02, p=0.031) in patients draining less than 500cc before removal. Free fluid (OR 3.05, p=0.009) and lack of colonic air (OR 6.67, p=0.002) on CT scan predicted operative management following attempted non-operative management on multivariate analysis.
NGT insertion for SBO is not based on objective findings. Patients with NGTs had increased risk of pneumonia, respiratory failure, increased time to resolution and HLOS.

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