Population-based study of the impact of small bowel obstruction due to adhesions on short- and medium-term mortality. Issue 13 (9th August 2019)

• Record Type: Journal Article
• Authors: Behman, R; Nathens, A B; Haas, B; Look Hong, N; Pechlivanoglou, P; Karanicolas, P
• Is Part Of: British journal of surgery. Volume 106:Issue 13(2019)
• Page Start: 1847
• Page End: 1854
• Publication Date: 2019-08-09
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.11284
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: Small bowel obstruction due to adhesions (aSBO) is a common indication for admission to a surgical unit. Despite the prevalence of this condition, the short- and medium-term survival of this patient population has not been well described. The purpose of this study was to measure the short- and medium-term survival of patients admitted to hospital with aSBO. Methods: Linked administrative data were used to identify patients admitted to hospital in Ontario, Canada, for aSBO between 2005 and 2011. Patients were divided into two groups: those aged less than 65 years (younger group) and those aged 65 years and older (older group). Thirty-day, 90-day and 1-year mortality rates were estimated. One-year mortality was compared with that in the general population, adjusting for age and sex. The timing of deaths in relation to admission was assessed, as well as the proportion of patients discharged before experiencing short-term mortality. Results: There were 22 197 patients admitted to hospital for aSBO for the first time in the study interval. Mean age was 64·5 years and 52·2 per cent of the patients were women. Overall, the 30-day, 90-day and 1-year mortality rates for the cohort were 5·7 (95 per cent c.i. 5·4 to 6·0), 8·7 (8·3 to 9·0) and 13·9 (13·4 to 14·3) per cent respectively. For both groups, the 1-year risk of death was significantly greater than that of the age-matched general population. The majority of deaths (62·5 per cent) occurred within 90 days of admission, with 36·4 per cent occurring after discharge from the aSBO admission. Conclusion: Patients admitted with aSBO have a high short-term mortality rate. Increased monitoring of patients in the early period after admission is advisable. Graphical Abstract: The risk of 30-day, 90-day and 1-year mortality is extremely high among patients admitted for adhesive small bowel obstruction. Moreover, more than one-third of deaths occur after discharge from hospital but within 90 days of the initial small bowel obstruction admission, suggesting that more careful monitoring of patients in this early period after admission may be critical. Higher than expected.