Summary
Background
Patients with intestinal malrotation with volvulus (MWV) may suffer bowel ischemia,
which can be correlated with the timing of surgical intervention. The purpose of this
study was to identify and assess time-blocks in the care of patients from initial
physician assessment (IPA) to surgical intervention to highlight potential opportunities
for improvement.
Methods
Retrospective chart review of patients with MWV presenting to McMaster Children’s
Hospital between January 1st, 2000 and December 31st, 2020 (n=31). Demographic data and time-blocks of care were identified and analyzed (p<0.05 considered significant). All times were reported as medians.
Results
22 males (71%) and 9 females (29%) were identified; median age was 9.8d. IPA to incision
was 10.7hrs and surgical consult to incision was 3.4hrs. Time to incision for patients
<1y was not significantly different than those >1y (10.5hrs vs 10.7hrs, p=0.737).
The use of ultrasound did not significantly affect time to incision (7.9hrs vs 12.0hrs,
p=0.128). For patients requiring resection or having pan-necrosis there was no significant
difference in time from IPA (10.9hrs vs 10.5hrs, p=0.238) or surgical consult to incision
(4.0hrs vs 3.3hrs, p=0.808).
Conclusion
Time from IPA to surgical consult and time from surgical consult to surgical intervention
represented the largest proportions of time. Age, use of ultrasound, and need for
resection or having pan-necrosis did not significantly affect the time to incision.
This data may be used to inform opportunities for expediting the management of patients
with MWV once they have presented to a physician.
Level of Evidence: III.
Keywords
Abbreviations:
Malrotation with Volvulus ((MWV))To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
January 5,
2023
Received:
January 3,
2023
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
