Initial Adhesive Small Bowel Obstruction Management Pathway Drives Infectious Complication Occurrence

Area of Science:

• Surgical outcomes research
• Gastrointestinal surgery
• Infectious disease epidemiology

Background:

• The Bologna guideline offers three management pathways for small bowel obstruction (SBO).
• The impact of pathway selection on post-operative infection rates remains under-investigated.

Purpose of the Study:

• To investigate the association between SBO management pathways and post-operative infection incidence.
• To compare outcomes between non-operative management (NOM) followed by surgery (NOM-T) and direct-to-surgery (DTS) pathways.

Main Methods:

• A multi-national, prospective, observational audit of 1,737 SBO patients across 21 countries.
• Patients were categorized into successful NOM, NOM-T, and DTS groups.
• Statistical comparisons used chi-square or Fisher exact tests (p < 0.05 significance).

Main Results:

• Operative cohorts (NOM-T vs. DTS) showed similar demographics but more comorbidities in NOM-T.
• Intestinal ischemia was higher in DTS (33%) versus NOM-T (22.8%).
• Deep surgical site infections (SSI) were more frequent in NOM-T (5.5%) compared to DTS (2.8%, p=0.035), despite similar overall SSI rates.

Conclusions:

• An initial trial of non-operative management before surgery for adhesive SBO may elevate the risk of deep SSI.
• Factors such as delayed time to operating room and hospital/surgeon variables likely contribute to increased deep SSI risk.
• Further evaluation of these contributing elements is warranted to optimize patient care.