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Assessment of Care Timelines in Intestinal Malrotation with Volvulus: A Retrospective Chart Review

  • Denise Sabac
    Affiliations
    Bachelor of Health Sciences (Honours) Program, McMaster University, Hamilton, Canada

    McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Canada
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  • Daniel Briatico
    Affiliations
    McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Canada

    Division of Pediatric General Surgery, Department of Surgery, McMaster University, Hamilton, Canada
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  • Peter Fitzgerald
    Correspondence
    Corresponding author. McMaster Children’s Hospital. 1200 Main Street West, Room 4E7. Hamilton, Ontario, Canada. L8N-3Z5.
    Affiliations
    McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Canada

    McMaster Children’s Hospital, Hamilton, Canada
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      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))
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