{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T01:02:01Z","timestamp":1788397321595,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2018,5,16]],"date-time":"2018-05-16T00:00:00Z","timestamp":1526428800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,5,16]],"date-time":"2018-05-16T00:00:00Z","timestamp":1526428800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The American Association for the Surgery of Trauma (AAST) anatomic severity grading system for adhesive small bowel obstruction (ASBO) has demonstrated to be a valid tool in North American patient populations. Using a multi\u2010national patient cohort, we retrospectively assessed the validity the AAST ASBO grading system and estimated disease severity in a global population in order to correlate with several key clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Multicenter retrospective review during 2012\u20132016 from four centers, Minnesota USA, Bologna Italy, Pietermaritzburg South Africa, and Bucharest Romania, was performed. Adult patients (age\u2009\u2265\u200918) with ASBO were identified. Baseline demographics, physiologic parameters, laboratory results, operative and imaging details, outcomes were collected. AAST ASBO grades were assigned by independent reviewers. Univariate and multivariable analyses with odds ratio (OR) and 95% confidence intervals (CIs) were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 789 patients with a median [IQR] age of 58 [40\u201375] years; 47% were female. The AAST ASBO grades were I (<jats:italic>n<\/jats:italic>\u2009=\u2009180, 23%), II (<jats:italic>n<\/jats:italic>\u2009=\u2009443, 56%), III (<jats:italic>n<\/jats:italic>\u2009=\u200987, 11%), and IV (<jats:italic>n<\/jats:italic>\u2009=\u200979, 10%). Successful non\u2010operative management was 58%. Conversion rate from laparoscopy to laparotomy was 33%. Overall mortality and complication and temporary abdominal closure rates were 2, 46, and 4.7%, respectively. On regression, independent predictors for mortality included grade III (OR 4.4 95%CI 1.1\u20137.3), grade IV (OR 7.4 95%CI 1.7\u20139.4), pneumonia (OR 5.6 95%CI 1.4\u201311.3), and failing non\u2010operative management (OR 2.4 95%CI 1.3\u20136.7).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The AAST EGS grade can be assigned with ease at any surgical facility using operative or imaging findings. The AAST ASBO severity grading system has predictive validity for important clinical outcomes and allows for standardization across institutions, providers, and future research. Disease severity and outcomes varied between countries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence III<\/jats:title><jats:p>Study type Retrospective multi\u2010institutional cohort study.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-018-4671-1","type":"journal-article","created":{"date-parts":[[2018,5,16]],"date-time":"2018-05-16T14:13:53Z","timestamp":1526480033000},"page":"3581-3588","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Application of the AAST EGS Grade for Adhesive Small Bowel Obstruction to a Multi\u2010national Patient Population"],"prefix":"10.1002","volume":"42","author":[{"given":"Matthew C.","family":"Hernandez","sequence":"first","affiliation":[{"name":"Division of Trauma, Critical Care and General Surgery, Department of Surgery Mayo Clinic 200 First Street SW 55905 Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Birindelli","sequence":"additional","affiliation":[{"name":"Department of Surgery Maggiore Hospital Bologna Italy"},{"name":"Department of Surgery, NHS Queen Elizabeth University Hospital Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John L.","family":"Bruce","sequence":"additional","affiliation":[{"name":"University of KwaZulu Natal Department of Surgery, Pietermaritzburg Metropolitan Complex Pietermaritzburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes J. 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