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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

Objective:
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?
Design:
Case series. Comparisons using the student’s t-test, Chi-square, and multivariate logistic regression.
Setting:
University tertiary referral center.
Patients:
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).
Interventions:
None
Main Outcome Measures:
Outcomes included days to resolution, complications, and hospital length of stay (HLOS).
Results:
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.
Conclusions:
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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