EP.FRI.798 Emergency surgery: Acute intestinal obstruction – how are we doing three years post NASBO guidelines?. (28th October 2021)

• Record Type: Journal Article
• Authors: Lafaurie, Guillaume; Butterwoh, James; Iakovou, Angeliki; Engeldow, Alec
• Is Part Of: British journal of surgery. Volume 108:Supplement 7(2021)
• Publication Date: 2021-10-28
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znab312.120
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Aims: 10% of emergency surgical admissions are due to acute intestinal obstruction. If surgery is required, the mortality is raised to 10%. The latest 2017 National Audit of Small Bowel Obstruction (NASBO) has identified several key investigative and therapeutic targets. Our aim is to look into our clinical practice and compare it to the NASBO standards. Methods: In a district general hospital (DGH), we prospectively collected data of 30 patients coming consecutively with acute small bowel obstruction looking into imaging, conservative management, surgical management and outcomes. Results: 30 patients were included in this study with mean age of 69 years (24-88 years old), with an average hospital stay of 7 days (1 - 46 days). Bowel obstruction aetiology included: 15 secondary to adhesions, 5 hernias, 4 crohns strictures and others. 28 patients had AXR on admission as well as CT with average time to CT of 13.4 hours from admission. A third received water soluble contrast, on average 32.9 hours after admission. A third patients required surgery, undertaken on average 60 hours from admission. The outcomes showed 25 recovering well and going home and a 30-day mortality of 13% (4/30). Seven patients received dietician input, two patients were reviewed by geriatricians before surgery and none post-operatively. Conclusion: From a previous review of our practice we improved in terms of instigating timely investigations and prompt decision to surgery. However, we need to clearly work towards a more holistic approach including dietician and geriatrician input within the complex post-operative management of these patients.