Thirty-day mortality in patients undergoing laparotomy for small bowel obstruction

Peacock, Oliver; Bassett, Mike G.; Kuryba, Angela; Walker, Kate; Davies, Emma; Anderson, I. D.; Vohra, Ravinder

doi:10.1002/bjs.10812

Cited by 54 publications

(43 citation statements)

References 19 publications

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“…The National Emergency Laparotomy Audit (NELA) score is a product of the national audit of the same name, which collected data from over 60,000 patients across England and Wales. The score to predict mortality within 30 days of emergency laparotomy uses 21 variables, one of which is ASA physical status .…”

Section: Risk Scores and Models That Incorporate Asa Physical Statusmentioning

confidence: 99%

A review of ASA physical status – historical perspectives and modern developments

2019

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Summary The American Society of Anesthesiologists (ASA) physical status is a tool commonly used to classify a patient's physical fitness before surgery. Since its introduction in 1941 it has undergone very few modifications to improve its reliability and to eliminate subjectivity, despite vast changes in both surgical and anaesthetic technique. We present the history of the ASA physical status and review the literature on its applicability to contemporary anaesthetic practice.

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Section: Risk Scores and Models That Incorporate Asa Physical Statusmentioning

confidence: 99%

A review of ASA physical status – historical perspectives and modern developments

2019

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“…Preoperative inter‐hospital transfer in general surgical patients delays surgical intervention and these patients have worse outcomes, even when matched per operation and comorbidities . There has been a trend towards centralization of surgical services, however, this is often not appropriate in the setting of emergency surgery where delay to surgical intervention may be fatal . It is important to note that although patients who were up‐transferred in the preoperative period were older and of higher risk there was no mortality reported in this cohort of RELA patients.…”

Section: Discussionmentioning

confidence: 81%

Rural Emergency Laparotomy Audit

Watson

Maddern

Mudalige

et al. 2019

ANZ Journal of Surgery

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Background: Emergency laparoscopy/laparotomy is associated with high levels of mortality. The aim of this study was to determine whether outcomes following emergency laparoscopy/ laparotomy in rural and regional South Australian hospitals were comparable to those reported in the National Emergency Laparotomy Audit and Perth Emergency Laparotomy Audit. Methods: A prospective multicentre audit of patients who undergo emergency laparoscopy/laparotomy. Participating hospitals included Mount Gambier and Districts Health Service, Whyalla Hospital and Riverland General Hospital. Inclusion and exclusion criteria were identical to the National Emergency Laparotomy Audit. A modified dataset for patients was collected if patients were up-transferred to another hospital prior to operative management. Data collected included patient demographics, operative management, adherence to processes of care and outcomes. Results: Data were collected for a total of 58 cases. Fifty-one of these had emergency laparoscopy/laparotomy in a rural or regional hospital and seven were transferred in the preoperative period. The median Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity predicted 30-day post-operative mortality was 3.5%. One hundred percent of patients (51 out of 51) had a consultant anaesthetist and surgeon present in the operating theatre. There were no deaths reported within the 30-day postoperative period. Conclusion: Outcomes following emergency laparoscopy/laparotomy in rural and regional South Australian hospitals are comparable to those reported in the National Emergency Laparotomy Audit and Perth Emergency Laparotomy Audit.

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“…Recent analysis of NELA outcomes in patients undergoing surgical intervention for adhesive SBO reported 30-day mortality at a very similar level of 7⋅2 per cent, with risk of death associated with increasing age, co-morbidity, outcome prediction score and degree of contamination at surgery. It also demonstrated the negative association between survival and delayed surgery 23 .…”

Section: Discussionmentioning

confidence: 89%

“…This study suggests that delayed surgery is associated with worse outcomes for patients with SBO. There are mitigating factors that may result in deferral of surgery, including need for preoperative resuscitation, likelihood of successful conservative management, anticipated complexity of surgery (such adhesiolysis within a hostile abdomen or in association with complex abdominal wall hernias), significant pre‐existing co‐morbidity or frailty, need for prolonged critical care admission, minimal chances of discharge from hospital and/or need for long‐term escalation in social care needs.…”

Section: Discussionmentioning

confidence: 90%

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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Thirty-day mortality in patients undergoing laparotomy for small bowel obstruction

Abstract: In patients who require an emergency laparotomy with adhesiolysis or resection for SBO, a delay to surgery of more than 72 h is associated with a higher 30-day postoperative mortality rate.

Cited by 54 publications

References 19 publications

A review of ASA physical status – historical perspectives and modern developments

A review of ASA physical status – historical perspectives and modern developments

Rural Emergency Laparotomy Audit

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

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