SP5.2.8 Management of Small Bowel Obstruction: Are we improving?. (9th August 2022)

• Record Type: Journal Article
• Authors: Cox, Kofi; Kenington, Cleo
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 5
• Publication Date: 2022-08-09
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac247.059
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Aims: Recently 2 national audits evaluating the management of small bowel obstruction (SBO) have been published, recommending areas for improvement (NASBO and NCEPOD: delay in transit). We conducted a retrospective audit to evaluate if the management of SBO at a University Hospital reflects these recommendations. Methods: The audit questionnaire and standards were designed using recommendations from the national audits. Patients were identified using hospital coding data over a 6-month period: February-July 2021. Patient data was extracted using electronic patient records. Results: 81 patients were identified. Adhesions (59%) and hernias (26%) were the predominant aetiologies. 53% were managed conservatively, 36% with early surgery and 11% with delayed surgery. 93% of cases received a CT; time to CT diagnosis was slower in patients also investigated with abdominal radiographs. Mean time from triage to CT diagnosis was 7.5 hours (2.2 days in NASBO). 84% of surgical cases arrived in theatre less than 72 hours after triage and 65% of conservatively managed cases received Gastrografin (28% in NASBO). Dietician review occurred in 68% of patients at moderate-severe risk of malnutrition (39% in NASBO). 48% of patients had urine output recorded within 24 hours of admission and AKI incidence was 14% (8% in NCEPOD: delay in transit). No surgical cases were successfully managed laparoscopically and 20% of frail patients had geriatrician input. Conclusion: Whilst improvements have been made since the NASBO and NCEPOD: delay in transit, fluid balance consideration, care of frail patients, laparoscopic surgery and use of abdominal radiographs remain key areas for improvement.