CESORCenter for Emergency Surgery Outcomes Research
IMPEL
Prospective international audit of mechanical large-bowel obstruction.
IMPEL is an international, time-bound prospective observational clinical snapshot audit that characterizes the epidemiology, diagnostic pathways, operative and non-operative management strategies, and short-term outcomes of mechanical large-bowel obstruction across real-world acute care settings. The platform supports benchmarking, defines variation in care, and preserves the structure required for decision-aligned comparative analyses in clinically coherent subgroups.
Leadership and governance
Gary Alan Bass, MD, MSc, MBA, PhD, FICS, FEBS (Emergency Surgery)
Assistant Professor of Surgery and Assistant Professor of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania
gary.bass@pennmedicine.upenn.edu
Matteo Maria Cimino, MD
IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan
cimino.matteo@gmail.com
Gabriele Bellio, MD
IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan
Gabriellebellio87@gmail.com
IMPEL is overseen through CESOR with representation from ESTES, ASGBI, ESCP, and ASCRS alongside senior emergency and colorectal surgery collaborators.
Why this study exists
Mechanical large-bowel obstruction is associated with substantial morbidity, mortality, stoma burden, and resource use. Yet the contemporary evidence base remains dominated by retrospective studies, cancer-specific cohorts, and single-center series, with recommendations often extrapolated from heterogeneous populations.
IMPEL captures acute-care practice: how patients are diagnosed, decompressed, selected for surgery, diverted, resected, and followed. The result is a structured map of current care that supports benchmarking and design-first comparative analysis.
Core objective
Management pathwaysDiagnostic strategy, operative timing, procedure choice, and stoma-related outcomes
Inclusion window
90 daysConsecutive eligible adults during a local 90-day study period
Short-term outcomes
30-day morbidity and mortalityWith inpatient course, complications, reintervention, and critical-care use
Patient-centered follow-up
6-month stoma statusPersistence, reversal, and late complications after index obstruction care
Design
International multicenter inclusion of consecutive adults with mechanical large-bowel obstruction using standardized prospective data capture and routinely collected clinical data only.
IMPEL records presenting physiology, imaging modality and timing, decompression attempts, endoscopic evaluation, and the interval from presentation to definitive management decisions.
The platform captures both operative and non-operative care, including urgency, approach, resection, anastomosis, stoma creation, staged strategies, and non-operative management patterns.
In-hospital course, critical care use, re-intervention, complications, discharge destination, and later stoma outcomes are captured to reflect the practical burden of emergency LBO care.
Decision-aligned analytic agenda
M1
M2
M3
Spin-off work
Stoma burden is part of the outcome, not an afterthought. IMPEL quantifies not only who survives the index admission, but how pathway selection shapes continuity restoration, later complications, and the medium-term consequences of emergency colorectal care.
That makes the platform more informative than a simple in-hospital audit and strengthens its benchmarking and comparative value.
For participating centers and collaborators
IMPEL is intended for centers able to support consecutive case ascertainment, structured prospective data capture, local governance approval, and follow-up through six months for stoma outcomes using routine clinical data. Acute care surgeons, colorectal surgeons, endoscopists, methodologists, and implementation collaborators can engage through CESOR’s participation pathways.
For participating centers
Centers interested in participation should contact CESOR and submit structured intake through the participation pathway.
For analysts and collaborators
Collaborators with relevant methodological, colorectal, emergency surgery, or systems expertise should review CESOR participation pathways before initial outreach.
Governance
Secondary analyses are subject to Steering Committee review, and only fully de-identified data are transferred centrally. The platform is built for international audit-style participation with local regulatory determination at each site.