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Updated: Mar 7, 2026
Author Spotlight: Assessing Surgical Frailty with Point-of-Care Ultrasound of Quadriceps Muscles
Published on: July 26, 2024
Small bowel obstruction and frailty: a systematic review
Aiman Ibrahim1, Joseph Froud1, Maria Lauda Tomasi2
1Gastrointestinal Surgery Department, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
Purpose:
To explore frailty within the context of small bowel obstruction (SBO) and identify the frailty screening tools used. Surgical decision-making in small bowel obstruction among older, frail adults poses distinct challenges for emergency surgical teams, often resulting in variation of care. Conservative management is frequently successful, yet the diminished physiological and functional reserve characteristic of frailty necessitates tailored treatment guided by comprehensive geriatric assessment (CGA).
Methods:
Following PRISMA principles, a systematic literature search was conducted across PubMed, Scopus, Cochrane, Web of Science, Embase, and CINAHL (July 2025). Studies investigating frailty in adults with small bowel obstruction were eligible. Two reviewers screened titles, abstracts, and full texts independently.
Results:
After removal of duplicates, 1109 records were screened; 31 full-text articles were reviewed, and 6 studies met the inclusion criteria. Frail patients consistently demonstrated higher mortality and longer hospital stay than non-frail cohorts. Four studies associated frailty with poorer outcomes, and four identified delays in surgery among older or frail patients. The largest study (≈50,000 patients) demonstrated that delayed intervention increased 30-day mortality, independent of confounders.
Conclusion:
Emerging data highlight the importance of frailty screening and CGA in older adults presenting with small bowel obstruction. Identifying those most frail and at risk may aid timely, individualised decision-making. Future work should determine whether earlier surgery in frail patients improves outcomes and inform the creation of specific guidance for frail and older adults with small bowel obstruction.
Registration Number:
PROSPERO 2025 CRD420251231786.
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