Practice variations in the surgical treatment of small bowel obstruction in Quebec
Bibliographic record
Abstract
Background: Small bowel obstruction (SBO) is a common emergency and selectively requires surgical management. There is growing evidence supporting the use of laparoscopic surgery (LS) compared to open surgery for SBO. Methods: An online survey-based cohort study examining surgeon characteristics, patient factors, and clinical situations that impact decision making regarding the use of LS for SBO was sent to the 538 members of the Association Québécoise de Chirurgie and their answers were collected over a 4-month period in 2019. Results: The response rate was 27.1% (n=146). The gender, sex or the practice setting did not have an impact on the surgical approach. It was noted that surgeons who were more comfortable with laparoscopy used it more often (P=0.002). The three factors favoring the initial approach by laparotomy were most frequently cited: hostile abdomen, severe abdominal distension, and hemodynamic instability. Young surgeons had more homogenous answers (P=0.03). The surgeons having a practice oriented into LS had different decision criteria compared to those doing more open surgery. Conclusion: This article emphasizes key clinical scenarios and determinants that shape the surgical strategy for SBO treatment. The authors aim for this research to stimulate more discussions and contemplation about using laparoscopic methods for treating SBO in certain patients, thereby potentially elevating the frequency of surgeons adopting this approach. Moreover, considering the existing literature supports LS as a viable and safe method for SBO treatment, and noting the enhanced outcomes for patients, it becomes increasingly vital to advocate for this conversation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".