Management and short-term outcomes of patients with small bowel obstruction in Denmark: a multicentre prospective cohort study

M Olausson, M P Aerenlund, M Azzam, T Bjerke, J F H Burcharth, C B Dibbern, T K Jensen, J Q Jordhøj, I Lolle, L Ngo-Stuyt, E Ø Nielsen, L B J Nielsen, A P Skovsen, M A Tolver, H G Smith, M Olausson, M P Aerenlund, M Azzam, T Bjerke, J F H Burcharth, C B Dibbern, T K Jensen, J Q Jordhøj, I Lolle, L Ngo-Stuyt, E Ø Nielsen, L B J Nielsen, A P Skovsen, M A Tolver, H G Smith

Abstract

Aims: The optimal management of small bowel obstruction (SBO) remains a matter of debate and treatment varies internationally. In Denmark, a more surgically aggressive strategy has traditionally been used, but to what extent patient outcomes differ from international reports is unknown. This study aimed to describe the current management and outcomes of patients admitted with SBO in Denmark.

Methods: This was a prospective cohort study conducted at six acute hospitals in Denmark over a 4-month period. Patients aged ≥ 18 years with a clinical or radiological diagnosis of SBO were eligible. Primary outcomes were 30 day morbidity and mortality rates.

Results: 316 patients were included during the study period. The median age was 72 years and 56% were female. Diagnosis was made by computed tomography (CT) in 313 patients (99.1%), with the remaining three diagnosed clinically. Non-operative management was the initial strategy in 152 patients (48.1%) and successful in 119 (78.3%). Urgent surgery was performed in the remaining 164 (51.9%), with a laparoscopic approach used in 84 patients (51.2%). The entire cohort had a 30 day mortality rate of 7.3% and a 30 day morbidity rate of 17.1%.

Conclusions: The management of SBO in Denmark differs markedly to previous international reports, with an almost ubiquitous use of CT for diagnosis and a high proportion of patients undergoing urgent surgery. Despite higher rates of surgery, patient outcomes are broadly similar to reports of more conservative strategies, perhaps due to a reduction in delayed operations.

Trial registration: Trial registration number: NCT04750811. Trial registration date: 11/02/2021.

Keywords: Emergency general surgery; Peri-operative outcomes; Small bowel obstruction.

Conflict of interest statement

None of the authors have conflicts of interest to declare.

© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

Figures

Fig. 1
Fig. 1
Aetiologies of small bowel obstruction stratified according to initial treatment strategy presented as A absolute numbers and B proportion of patients in each group
Fig. 2
Fig. 2
The previous surgical history of patients undergoing urgent operations for small bowel obstruction. A The number of previous operations in those undergoing subsequent open or laparoscopic surgery for small bowel obstruction. B The type of previous operations in those undergoing subsequent open or laparoscopic surgery for small bowel obstruction

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Source: PubMed

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