Current management of small bowel obstruction in the UK: results from the National Audit of Small Bowel Obstruction clinical practice survey

Lee, Matthew J.; Sayers, Adele E.; Wilson, Timothy R.; Acheson, Austin G; Anderson, I. D.; Fearnhead, Nicola

doi:10.1111/codi.14016

Cited by 36 publications

(32 citation statements)

References 30 publications

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“…Replies were received from the majority of hospitals in the UK, including 104 of 135 (77%) acute NHS Trusts in England. The survey was sent to 848 recipients, of whom 242 replied, a 29% response rate, which is in line with response rates for other surveys of this type . Respondents were predominantly male (85%) and working in England (85%), with smaller numbers from Scotland (19, 8%), Wales (12, 5%) and Northern Ireland (5, 2%).…”

Section: Resultsmentioning

confidence: 58%

Emergency general surgeons, subspeciality surgeons and the future management of emergency surgery: results of a national survey

et al. 2018

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Aim This study aimed to survey consultants’ experience of working as or with emergency general surgery (EGS) surgeons and to investigate the role they fulfil in the management of general and subspeciality emergencies. Method An electronic survey, designed to capture both quantitative and qualitative data, was piloted and then circulated to members of the Association of Coloproctology of Great Britain and Ireland. Results Two hundred and forty‐two responses were received from 848 recipients (a 29% response rate) covering 104 of 135 (77%) acute NHS Trusts in England. EGS surgeons were in post in 43/141 (30%) hospitals overall and 12/24 (50%) of hospitals in London. Most respondents working in units with EGS surgeons found them to be advantageous (46/63, 73%). Consultants working with EGS surgeons were significantly more likely to support their use (49/63, 78%) than those without them (83/178, 47%) (χ2 = 16.9, P < 0.001). EGS surgeons were considered to improve the delivery of EGS (78%), create time for subspecialists (70%) and provide service (73%). However, there were concerns about the quality of surgery (43%), an insufficient standard of specialist care (54%) and compromise in the training of juniors (25%). Respondents commented on a lack of job structure with a high attrition rate (21%), the insufficient quality of applicants (18%) and that subspecialization and split on‐call was preferable (17%). Conclusion Respondents were supportive of the ability of EGS surgeons to relieve pressure on subspecialists; however, there were significant concerns about the sustainability and quality of the EGS surgeon role. Emergency colorectal resections should have the input of a surgeon who performs elective colorectal resections.

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Section: Resultsmentioning

confidence: 58%

Emergency general surgeons, subspeciality surgeons and the future management of emergency surgery: results of a national survey

et al. 2018

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“…Only 50-60% of surgeons would consider using laparoscopy for small bowel obstruction in surveys carried out in the UK and Connecticut. 14,15 The lack of widespread adoption can be appointed to three major reasons: laparoscopic adhesiolysis is technically demanding, 3 it has been associated with higher risk of iatrogenic bowel injury, 12 and, to our knowledge, there is no randomised evidence of benefit and safety. 8,10,11,13 Because of controversy regarding the safety and benefits of laparoscopic adhesiolysis over open approach for small bowel obstruction, we conducted LAparoscopic versuS open adhesiolysis for adhesive Small bowel Obstruction (LASSO) trial.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic versus open adhesiolysis for adhesive small bowel obstruction (LASSO): an international, multicentre, randomised, open-label trial

Sallinen

Saverio

Haukijärvi

et al. 2019

The Lancet Gastroenterology & Hepatology

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“…Patients undergoing initial conservative management of adhesive SBO could receive water‐soluble contrast agents to stratify whether or not the obstruction is likely to resolve without surgery. Although many surgeons report that they would consider this test, only 21·6 per cent of patients received it in the present study. Barriers to the adoption of water‐soluble contrast in managing patients with adhesive SBO require further investigation.…”

Section: Discussionmentioning

confidence: 94%

National prospective cohort study of the burden of acute small bowel obstruction

et al. 2019

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Background Small bowel obstruction is a common surgical emergency, and is associated with high levels of morbidity and mortality across the world. The literature provides little information on the conservatively managed group. The aim of this study was to describe the burden of small bowel obstruction in the UK. Methods This prospective cohort study was conducted in 131 acute hospitals in the UK between January and April 2017, delivered by trainee research collaboratives. Adult patients with a diagnosis of mechanical small bowel obstruction were included. The primary outcome was in‐hospital mortality. Secondary outcomes included complications, unplanned intensive care admission and readmission within 30 days of discharge. Practice measures, including use of radiological investigations, water soluble contrast, operative and nutritional interventions, were collected. Results Of 2341 patients identified, 693 (29·6 per cent) underwent immediate surgery (within 24 h of admission), 500 (21·4 per cent) had delayed surgery after initial conservative management, and 1148 (49·0 per cent) were managed non‐operatively. The mortality rate was 6·6 per cent (6·4 per cent for non‐operative management, 6·8 per cent for immediate surgery, 6·8 per cent for delayed surgery; P = 0·911). The major complication rate was 14·4 per cent overall, affecting 19·0 per cent in the immediate surgery, 23·6 per cent in the delayed surgery and 7·7 per cent in the non‐operative management groups ( P < 0·001). Cox regression found hernia or malignant aetiology and malnutrition to be associated with higher rates of death. Malignant aetiology, operative intervention, acute kidney injury and malnutrition were associated with increased risk of major complication. Conclusion Small bowel obstruction represents a significant healthcare burden. Patient‐level factors such as timing of surgery, acute kidney injury and nutritional status are factors that might be modified to improve outcomes.

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Current management of small bowel obstruction in the UK: results from the National Audit of Small Bowel Obstruction clinical practice survey

Abstract: This survey demonstrates consensus on imaging requirements and indications for early surgery in the management of SBO. Significant variation exists around awareness of the need for nutritional support in patients with SBO, and on strategies to achieve this support.

Cited by 36 publications

References 30 publications

Emergency general surgeons, subspeciality surgeons and the future management of emergency surgery: results of a national survey

Emergency general surgeons, subspeciality surgeons and the future management of emergency surgery: results of a national survey

Laparoscopic versus open adhesiolysis for adhesive small bowel obstruction (LASSO): an international, multicentre, randomised, open-label trial

National prospective cohort study of the burden of acute small bowel obstruction

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