Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17⋅7 per cent) had SBO due to hernia. Surgery was performed in 312 (75⋅2 per cent) of the 415 patients; small bowel resection was required in 198 (63⋅5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32⋅1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9⋅4 per cent (39 of 415), and was highest in patients with a groin hernia (11⋅1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16⋅3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1⋅05, 95 per cent c.i. 1⋅01 to 1⋅10; P = 0⋅009) and complications (odds ratio 1⋅05, 95 per cent c.i. 1⋅02 to 1⋅09; P = 0⋅001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group. *Members of the National Audit of Small Bowel Obstruction (NASBO) Steering Group and NASBO Collaborators are co-authors of this study and are listed in Appendix S1 (supporting information) Funding information
We performed below the IBD audit for: • Sigmoidoscopy in 72 hours (28% vs 99%) • Prescribing Ca/vit D (65% vs 74%) • Median time to surgery (9 vs 7.5 days) Important standards of IBD nurse and dietician review maintained. Delay in endoscopic evaluation and therefore time to surgery indicate there has been a slipping of standards in ASC care. This may be related to less direct ward continuity.Our data show a drop in performance (access to endoscopy and time to surgery). They have allowed us to critically appraise our acute IBD service thus leading to care delivery change and an education package for medical and surgical directorates. A repeat audit is planned in 24 months to demonstrate quality improvement as a result of this.
Background
We are now in the multi-drug era for ulcerative colitis (UC). The use of advanced therapies for UC has dramatically increased over the last 6 years. NICE approvals of anti-TNF and anti-α4β7 therapy (both in 2015) were followed by IL12/23 (2019) and janus kinase inhibitors (2020). The aim of this study was to describe the impact of this change in patterns of advanced therapy prescribing on colectomy rates for UC within a well defined population-based cohort.
Methods
The Lothian IBD registry (LIBDR) is a manually validated, prevalent dataset compiled through capture-recapture methodology (Jones et al. 2018) that is >95% complete for the 907,580 residents of NHS Lothian (mid-2019 population estimates). The LIBDR contains measured prevalence between 2008–2018, estimated prevalence from 2018–2028 (derived from Autoregressive integrated moving average {ARIMA} modelling). All patients with a diagnosis of UC who underwent a colectomy in Lothian, Scotland between 01/01/2005 and 31/102021 were identified by interrogating multiple clinical and administrative databases. Linear and segmental regression analyses were used to identify the annual percentage change (APC) and temporal trends (statistical joinpoints) in colectomy rates.
Results
485 patients underwent colectomy for UC between 2005 and October 2021 (Fig 1). Colectomy rates per 100 UC patients fell from 1.47 colectomies in 2005 to 0.25 in 2021 (p=0.009). The colectomy APC decreased by 4.1% per year between 2005 and 2014 and 18.5% per year between 2014 and 2021 (Figure 2). Temporal trend analysis (2005–2021) identified a significant joinpoint in colectomy rates in 2014 (p=0.009) (Figure 2).
Figure 1 Absolute number of colectomies for UC per year between 2005–2021. Linear regression showing colectomy numbers (solid line) and 95% confidence intervals (dashed lines) constrained at 2014.
Figure 2, Colectomy rates per 100 UC patients from 2005–2021. Joinpoint regression separated at inflection point at 2014 (solid line).
Between 2005 and 2007, 0 / 100 patients undergoing colectomy received maintenance biologic treatment prior to the admission for colectomy. Between 2019 and 2021, 19 / 33 (57.8%) patients received maintenance biologic therapy prior to colectomy (Figure 3).
Figure 3. Percentage of colectomy patients who had been treated with at least 1 maintenance biologic prior to surgery.
Conclusion
This population based cohort study has shown a significant reduction in the rate of colectomy for UC that has coincided with the introduction of biologic medication. Whilst we cannot ascribe causality, within this study the timeline of falling colectomy rates closely parallels the rapid increase in the use of biologic medication.
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