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

Area of Science:

• Surgical outcomes research
• Gastrointestinal surgery
• Emergency medicine

Background:

• Small bowel obstruction (SBO) frequently necessitates emergency laparotomy.
• Current surgical timing for SBO varies, with limited evidence on delayed surgery's impact.
• This study investigates the relationship between time to operation and 30-day mortality in SBO patients.

Purpose of the Study:

• To evaluate the effect of surgical delay on 30-day mortality in patients with SBO requiring emergency laparotomy.
• To identify risk factors associated with increased mortality after emergency laparotomy for SBO.
• To provide evidence-based recommendations on optimal surgical timing for SBO.

Main Methods:

• Utilized data from the National Emergency Laparotomy Audit (NELA) (December 2013 - November 2015).
• Included 9991 adult patients undergoing emergency laparotomy for SBO (adhesiolysis or resection).
• Analyzed 30-day mortality using multilevel logistic regression, comparing outcomes based on time to surgery (<24h, 24-72h, >72h).

Main Results:

• Overall 30-day mortality was 7.2% (722 patients).
• Factors like increasing age, ASA grade, and contamination worsened mortality.
• Emergency laparotomy delayed over 72 hours showed a significantly higher risk-adjusted 30-day mortality (OR 1.39, 95% CI 1.09-1.76).

Conclusions:

• A delay in emergency laparotomy exceeding 72 hours for SBO is associated with increased 30-day postoperative mortality.
• Timely surgical intervention is crucial for improving outcomes in SBO patients.
• Findings support the need for standardized surgical timing protocols for SBO.