Use and Outcomes of Dexamethasone in the Management of Malignant Small Bowel Obstruction

Frank F Yang; Elina Serrano; Kyle S Bilodeau; Michael Weykamp; Caitlin J Silvestri; Ashleigh C M Bull; Brenda Lin; Sara L Schaefer; Colette Galet; Luis J Garcia; Baraka Gitonga; David T Kolodziej; Samantha Esposito; Molly Parker-Brigham; Rohan Luhar; Avinash Mamgain; Kendrick C Brown; Summer Dewdney; Thea P Price; Nicole Siparsky; Sarah Knerr; Pauline K Park; Sabrina Sanchez; Dionne A Skeete; Katherine N Fischkoff; David R Flum

doi:10.1097/AS9.0000000000000431

Use and Outcomes of Dexamethasone in the Management of Malignant Small Bowel Obstruction

Ann Surg Open. 2024 May 6;5(2):e431. doi: 10.1097/AS9.0000000000000431. eCollection 2024 Jun.

Authors

Frank F Yang¹, Elina Serrano¹, Kyle S Bilodeau¹, Michael Weykamp¹, Caitlin J Silvestri², Ashleigh C M Bull³, Brenda Lin⁴, Sara L Schaefer⁵, Colette Galet³, Luis J Garcia³, Baraka Gitonga¹, David T Kolodziej³, Samantha Esposito⁶, Molly Parker-Brigham⁶, Rohan Luhar⁶, Avinash Mamgain⁶, Kendrick C Brown⁶, Summer Dewdney⁶, Thea P Price⁶, Nicole Siparsky⁶, Sarah Knerr⁷, Pauline K Park⁵, Sabrina Sanchez⁴, Dionne A Skeete³, Katherine N Fischkoff², David R Flum¹

Affiliations

¹ From the Department of Surgery, University of Washington, Seattle, WA.
² Department of Surgery, Columbia University Irving Medical Center, New York, NY.
³ Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA.
⁴ Department of Surgery, Boston University, Boston, MA.
⁵ Department of Surgery, University of Michigan, Ann Arbor, MI.
⁶ Department of Surgery, Rush University Medical Center, Chicago, IL.
⁷ Department of Health Systems and Population Health, University of Washington, Seattle, WA.

Abstract

Objective: To describe rates of dexamethasone use in the nonoperative management of malignant small bowel obstruction (mSBO) and their outcomes.

Background: mSBO is common in patients with advanced abdominal-pelvic cancers. Management includes prioritizing quality of life and avoiding surgical intervention when possible. The use of dexamethasone to restore bowel function is recommended in the National Comprehensive Cancer Network guidelines for mSBO. Yet, it is unknown how often dexamethasone is used for mSBO and whether results from nonresearch settings support its use.

Methods: This is a multicenter retrospective cohort study including unique admissions for mSBO from January 1, 2019 to December 31, 2021. Dexamethasone use and management outcomes were summarized with descriptive statistics and multiple logistic regression.

Results: Among 571 admissions (68% female, mean age 63 years, 85% history of abdominal surgery) that were eligible and initially nonoperative, 26% [95% confidence interval (CI) = 23%-30%] received dexamethasone treatment (69% female, mean age 62 years, 87% history of abdominal surgery). Dexamethasone use by site ranged from 13% to 52%. Among dexamethasone recipients, 13% (95% CI = 9%-20%) subsequently required nonelective surgery during the same admission and 4 dexamethasone-related safety-events were reported. Amongst 421 eligible admissions where dexamethasone was not used, 17% (95% CI = 14%-21%) required nonelective surgery. Overall, the unadjusted odds ratio (OR) for nonelective surgery with dexamethasone use compared to without its use was 0.7 (95% CI = 0.4-1.3). Using multiple logistic regression, OR after adjusting for site, age, sex, history of abdominal surgery, nasogastric tube, and Gastrografin use was 0.6 (95% CI = 0.3-1.1).

Conclusion: Dexamethasone was used in about 1 in 4 eligible mSBO admissions with high variability of use between tertiary academic centers. This multicenter retrospective cohort study suggested an association between dexamethasone use and lower rates of nonelective surgery, representing a potential opportunity for quality improvement.

Keywords: dexamethasone; mSBO; nonoperative management.