National prospective cohort study of the burden of acute small bowel obstruction

M J Lee; A E Sayers; T M Drake; P J Marriott; I D Anderson; S P Bach; M Bradburn; D Hind; A Verjee; N S Fearnhead; NASBO steering group and NASBO collaborators

doi:10.1002/bjs5.50136

National prospective cohort study of the burden of acute small bowel obstruction

BJS Open. 2019 Feb 22;3(3):354-366. doi: 10.1002/bjs5.50136. eCollection 2019 Jun.

Authors

M J Lee^{1

2}, A E Sayers^{2

3}, T M Drake^{2

4}, P J Marriott^{5

6}, I D Anderson⁷, S P Bach⁸, M Bradburn⁹, D Hind⁹, A Verjee¹⁰, N S Fearnhead¹¹; NASBO steering group and NASBO collaborators

Collaborators

NASBO steering group and NASBO collaborators:
John Abercrombie, Austin Acheson, Derek Alderson, Iain Anderson, Michael Davies, Zaed Hamady, Marianne Hollyman, Sarah Hare, Ellen Lee, John Northover, Christopher Lewis, Malcolm McFall, Aravinth Murugananthan, David Murray, Pritam Singh, Gillian Tierney, Ciaran Walsh, Jonathan Wild, Timothy Wilson, S Abbott, Y Abdulaal, S Afshar, J Ah-Chuen, T Ahmed, M Akhtar, F Akram, E Aldred, A Ali, M Aly, A Amajuoyi, V Amin, D Anderson, O Anderson, A Andreou, A Ansari, S Appleton, R Ardley, F Arshad, O Ashour, A Asour, A Athem, M Athersmith, F Ayoub, H Azeem, B Azhar, T Badenoch, C Baillie, D Bandyopadhyay, J Barker, S Barker, B Barkham, R Baron, J Barrie, E Barry-Yarrow, G Bashir, N Battersby, G Bazoua, N Behar, S Bellam, C Berger, S Bhandari, S Bhasin, S Biggs, C Bisset, L Blake, N Blencowe, T Boam, A Boddy, C Boereboom, M Bogdan, R Bogle, P Bohra, M Boland, H Bolkan, C Borg, R Boulton, G Bouras, M Boyer, J Boyle, G Branagan, H Brewer, C Briggs, J Broadhurst, E Brown, J Brown, L Brown, O Brown, K Burns, K Butcher, M Butler, B Byrne, L Campbell, C Capper, M Cartmell, T Cash, S Chan, N Chandratreya, J Chapman, S Chapman, A Charalabopoulos, C Cheek, S Chok, W Choong, M Chow, J Chowdhury, P Coe, P Conaghan, G Conn, N Cook, T Cook, S Cooper, J Cornish, D Cotton, C Cox, P Coyne, R Crook, J Crozier, G Cuffolo, P Cunha, N Curtis, J Cutting, K Da Costa, L da Silva, B Das, M Davenport, J Davies, T Davies, A Day, S Dayal, S Dean, G Demetriou, F Dengu, R Dennis, H Dent, P Dent, M Deputy, L Devoto, G Di Benedetto, S Dindyal, E Donnelly, P Doody, E Douka, C Downham, H Dowson, H Edent, K Edgerton, N Ekpete, M El Farran, O Elamin, M Eljaafari, N Elsaid, M El-Sharif, J Evans, M Evans, R Ewe, A Ewing, K Exarchou, R Fallaize, M Faoury, S Farag, E Farinella, G Faulkner, H Ferguson, O Fisher, J Fletcher, A Forouzanfar, A Foster, R Fox, N Francis, V Fretwell, D Fung, E Gammeri, J Garnham, A Geraghty, A Gilbert, C Gill, M Gill, M Gillespie, P Giordano, J Glasbey, M Goh, A Golder, N Green, T Gregoir, T Grey, E Groundwater, T Grove, S Growcott, S Gunasekaran, H Habib, J Haddow, V Halahakoon, C Halkias, C Hall, A Hampson, L Hancock, T Hanna, J Hannay, A Harikrishnan, R Harries, G Harris, J Hartley, K Harvey, P Hawkin, J Hawkins, R Healy, R Heard, R Heartshorne, S Heller, L Hendra, P Herrod, N Heywood, G Hicks, B Hobson, S Holtham, S Holtham, C Hope, P Hopley, T Hossain, S Hossaini, F Howse, T Hubbard, A Humphreys, H Ikram, M Ioannis, M Iqbal, N Iqbal, R Jain, J Jatania, P Jenkinson, S Jokhan, A Jones, C Jones, L Jones, H Joshi, K Joshi, M Joy, P Jull, G Kakaniaris, G Kakaniaris, R Kallam, E Kane, P Kang, R Kanitkar, S Kauser, F Kazmi, M Kedrzycki, S Kelly, J Kendall, M Khan, T Khan, G King, A Kisiel, C Kitsis, I Kolawole, S Korambayil, S Kosasih, A Kosti, A Kotb, S Kouris, K Kshatriya, S Kumar, G Lafaurie, R Lal, A Lau, T Lazim, T Lazim, A Lazzaro, K Lee, R Lefroy, D Leinhardt, D Leinhardt, H Lennon, K Leong, B Levy, E Lim, J Lim, S Lindley, D Liu, P Lloyd, D Locker, S Lockwood, C Lowe, J Lund, R Lunevicius, A Lunt, S Lutfi, A Luther, S Luwemba, P Mahankali-Rao, S Mahroof, D Mai, S Majid, A Malik, K Malik, K Mann, S Mansour, N Manu, R Mapara, C Martin, J Martin, R Martin, C Mason, L Massey, J Mathias, P Mathur, K Maude, D McArthur, S McCain, S McCluney, B McIlroy, S McKay, N McKinley, A McNair, D McWhirter, P Mekhail, K Mellor, J Merchant, L Merker, D Messenger, A Miles, S Mir, A Mishra, P Mistry, V Miu, M Moat, K Mockford, E Mohamed, I Mohamed, M Mondragon-Pritchard, N Moore, L Moretti, H Morris, T Morrison, V Morrison-Jones, J Moss, S Moug, D Mountford, R Moynihan, K Muhammad, D Muldoon-Smith, J Mulholland, M Mullan, E Murgitroyd, K Murugaiyan, A Myers, I Mykoniatis, G Nana, T Nash, A Nassar, R Newton, C Ng, P Ng, P Ng, K Nguyen, K Nguyen, F Nicholas, M Noor, J Nowers, C Nugent, A Nunn, R Nunn, N Obeid, J O'Callaghan, R O'Hara, O Oke, J Olivier, A O'Neill, S O'Neill, D Osei-Bordom, L Osgood, S Panagiotopoulos, B Panchasara, R Parks, H Patel, P Patel, R Patel, S Patel, K Pawelec, C Payne, K Pearson, G Perin, I Peristerakis, B Petronio, L Phelan, J Phillips, C Pisaneschi, J Pitt, K Plunkett-Reed, L Ponchietti, A Pouzi, M Pouzi, A Powell, A Powell-Chandler, N Pranesh, V Proctor, S Pywell, A Qureshi, N Qureshi, M Rahman, Z Rai, S Ramcharan, K Rangarajan, M Rashid, H Reader, A Rehman, S Rehman, C Rengifo, E Richards, N Richardson, A Robinson, D Robinson, B Rossi, F Rutherford, I Sadien, T Saghir, K Sahnan, G Salahia, J Sarveswaran, M Saunders, B Scott, K Scott, A Seager, S Seal, E Sezen, F Shaban, P Shah, P Shah, M Shahmohammadi, A Shamsiddinova, S Shankar, A Sharpe, V Shatkar, A Sheel, T Shields, M Shinkwin, J Shurmer, A Siddika, S Siddiqui, R Simson, P Sinclair, B Singh, S Singh, J Sivaraj, P Skaife, B Skelly, A Skinner, N Slim, C Smart, N Smart, F Smith, I Smith, R Smith, G Spence, A Sreedhar, J Steinke, L Stevenson, E Stewart-Parker, M Stott, B Stubbs, B Stubbs, N Stylianides, S Subramonia, M Swinkin, M Swinscoe, N Symons, W Tahir, T Taj, K Takacs, J Tam, K Tan, S Tani, N Tanner, D Tao, M Taylor, B Thava, K Thippeswamy, C Thomas, E Thompson, R Thompson, C Thompson-Reil, C Thorn, F Tongo, G Toth, A Turnbull, J Turnbull, C Valero, G van Boxel, M Varcada, M Venn, N Ventham, M Venza, D Vimalachandran, I Virlos, T Wade, A Wafi, K Waite, M Walker, N Walker, T Walker, U Walsh, S Wardle, R Warner, J Watfah, N Watson, J Watt, J Watts, J Wayman, C Weegenaar, H West, M West, L Whitehurst, M Whyler, M Wiggans, S Wijeyekoon, G Williams, R Williams, A Williamson, J Williamson, J Wilson, A Winter, L Wolpert, J Wong, E Yeap, T Yeong, S Zaman, B Zappa, D Zosimas, S Abbott, Y Abdulaal, S Afshar, M Akhtar, D Anderson, S Appleton, D Bandyopadhyay, G Bashir, N Behar, S Bhandari, G Branagan, R Boulton, C Borg, G Bouras, J Boyle, H Brewer, L Brown, C Briggs, M Cartmell, S Chan, N Chandratreya, P Conaghan, J Cornish, D Cotton, P Coyne, J Crozier, T Cook, P Cunha, N Curtis, A Day, S Dayal, R Dennis, P Dent, H Dowson, R Fallaize, S Farag, M El Farran, G Faulkner, P Giordano, T Grey, V Halahakoon, J Hannay, A Harikrishnan, S Holtham, P Hawkin, C Hall, L Hancock, J Hartley, F Howse, R Kallam, G Kakaniaris, S Kelly, S Lockwood, D Leinhardt, B Levy, R Lal, T Lazim, J Lund, R Lunevicius, P Mathur, K Maude, D McArthur, B McIlroy, A Miles, M Moug S Mondragon-Pritchard, D Messenger, M Mullan, A Myers, K Muhammad, C Mason, J Sarveswaran, V Shatkar, B Singh, B Skelly, S Subramonia, M Swinscoe, B Thava, C Thorn, S Panagiotopoulos, P Patel, J Phillips, I Peristerakis, A Qureshi, M Saunders, P Shah, A Sheel, S Siddiqui, P Skaife, N Smart, I Smith, L Stevenson, N Stylianides, J Steinke, B Stubbs, R Thompson, M Varcada, D Vimalachandran, I Virlos, J Watfah, N Watson, M Walker, N Ventham, H West, J Wilson, S Wijeyekoon, J Ah-Chuen, T Ahmed, F Akram, E Aldred, A Ali, M Aly, A Amajuoyi, V Amin, A Andreou, A Ansari, R Ardley, F Arshad, O Ashour, A Asour, F Ayoub, H Azeem, B Azhar, C Baillie, J Barker, B Barkham, R Baron, J Barrie, E Barry-Yarrow, N Battersby, G Bazoua, C Berger, S Bhasin, S Biggs, C Bisset, N Blencowe, A Boddy, C Boereboom, M Bogdan, R Bogle, P Bohra, H Bolkan, M Boyer, J Broadhurst, E Brown, J Brown, K Burns, K Butcher, C Capper, T Cash, J Chapman, S Chapman, A Charalabopoulos, C Cheek, S Chok, W Choong, J Chowdhury, P Coe, G Conn, N Cook, S Cooper, C Cox, R Crook, G Cuffolo, L da Silva, B Das, M Davenport, J Davies, T Davies, S Dean, G Demetriou, F Dengu, H Dent, G Di Benedetto, S Dindyal, E Donnelly, E Douka, C Downham, H Edent, K Edgerton, M El-Sharif, O Elamin, N Elsaid, J Evans, M Evans, R Ewe, A Ewing, H Ferguson, O Fisher, J Fletcher, A Forouzanfar, A Foster, R Fox, N Francis, V Fretwell, D Fung, E Gammeri, J Garnham, A Geraghty, A Gilbert, M Gill, M Gillespie, J Glasbey, A Golder, N Green, E Groundwater, T Grove, H Habib, J Haddow, C Halkias, A Hampson, T Hanna, R Harries, K Harvey, J Hawkins, R Healy, R Heartshorne, S Heller, L Hendra, P Herrod, N Heywood, G Hicks, P Ng, S Holtham, C Hope, P Hopley, T Hossain, S Hossaini, T Hubbard, A Humphreys, H Ikram, M Ioannis, M Iqbal, J Jatania, P Jenkinson, S Jokhan, A Jones, C Jones, L Jones, H Joshi, K Joshi, M Joy, P Jull, G Kakaniaris, E Kane, R Kanitkar, S Kauser, F Kazmi, M Kedrzycki, J Kendall, T Khan, G King, A Kisiel, C Kitsis, I Kolawole, S Kosasih, A Kosti, A Kotb, A Lau, G Lafaurie, T Lazim, A Lazzaro, R Lefroy, D Leinhardt, H Lennon, K Leong, E Lim, J Lim, S Lindley, D Liu, P Lloyd, D Locker, C Lowe, A Lunt, S Lutfi, A Luther, S Luwemba, P Mahankali-Rao, D Mai, S Majid, A Malik, N Manu, R Mapara, C Martin, J Martin, L Massey, J Mathias, S McCain, S McCluney, A McNair, P Mekhail, J Merchant, L Merker, S Mir, P Mistry, V Miu, M Moat, E Mohamed, I Mohamed, N Moore, L Moretti, H Morris, T Morrison, J Moss, D Mountford, R Moynihan, D Muldoon-Smith, J Mulholland, E Murgitroyd, K Murugaiyan, I Mykoniatis, G Nana, T Nash, A Nassar, R Newton, P Ng, K Nguyen, K Nguyen, F Nicholas, M Noor, J Nowers, C Nugent, A Nunn, J O'Callaghan, R O'Hara, A O'Neill, J Olivier, D Osei-Bordom, L Osgood, B Panchasara, R Parks, H Patel, K Pawelec, C Payne, K Pearson, G Perin, B Petronio, L Phelan, C Pisaneschi, J Pitt, L Ponchietti, A Powell, A Powell-Chandler, N Pranesh, V Proctor, N Qureshi, M Rahman, Z Rai, S Ramcharan, K Rangarajan, M Rashid, H Reader, A Rehman, S Rehan, C Rengifo, N Richardson, A Robinson, D Robinson, B Rossi, F Rutherford, I Sadien, T Saghir, K Sahnan, G Salahia, B Scott, K Scott, A Seager, S Seal, E Sezen, F Shaban, P Shah, M Shahmohammadi, A Shamsiddinova, S Shankar, A Sharpe, T Shields, M Shinkwin, J Shurmer, A Siddika, R Simson, S Singh, J Sivaraj, A Skinner, C Smart, F Smith, R Smith, A Sreedhar, E Stewart-Parker, M Stott, B Stubbs, N Symons, T Taj, J Tam, K Tan, S Tani, D Tao, K Thippeswamy, C Thomas, E Thompson, C Thompson-Reil, F Tongo, G Toth, A Turnbull, J Turnbull, T Wade, A Wafi, K Waite, N Walker, T Walker, U Walsh, S Wardle, R Warner, J Watt, J Watts, J Wayman, C Weegenaar, M West, M Whyler, L Whitehurst, M Wiggans, G Williams, R Williams, A Williamson, J Williamson, A Winter, L Wolpert, J Wong, G van Boxel, E Yeap, S Zaman, B Zappa, D Zosimas, O Anderson, A Athem, M Athersmith, T Badenoch, S Barker, S Bellam, T Boam, M Boland, L Blake, O Brown, M Butler, B Byrne, L Campbell, M Chow, K Da Costa, J Cutting, M Deputy, L Devoto, P Doody, N Ekpete, M Eljaafari, K Exarchou, M Faoury, E Farinella, C Gill, M Goh, T Gregoir, S Growcott, S Gunasekaran, G Harris, R Heard, B Hobson, N Iqbal, R Jain, P Kang, M Khan, S Korambayil, S Kouris, K Kshatriya, S Kumar, K Lee, S Mahroof, K Malik, K Mann, S Mansour, R Martin, S McKay, N McKinley, D McWhirter, K Mellor, A Mishra, K Mockford, V Morrison-Jones, C Ng, R Nunn, S O'Neill, O Oke, N Obeid, R Patel, S Patel, K Plunkett-Reed, M Pouzi, S Pywell, E Richards, P Sinclair, N Slim, G Spence, M Swinkin, W Tahir, K Takacs, N Tanner, M Taylor, C Valero, M Venn, M Venza, T Yeong

Affiliations

¹ Department of General Surgery Northern General Hospital Sheffield UK.
² South Yorkshire Surgical Research Group Sheffield UK.
³ Department of General Surgery Doncaster Royal Infirmary Doncaster UK.
⁴ Department of Clinical Surgery University of Edinburgh Edinburgh UK.
⁵ Department of General Surgery Warwick Hospital Warwick UK.
⁶ Department of General Surgery Salford Royal Infirmary Salford UK.
⁷ West Midlands Research Collaborative, Academic Department of Surgery Queen Elizabeth Hospital Birmingham UK.
⁸ Academic Department of Surgery Queen Elizabeth Hospital Birmingham UK.
⁹ Clinical Trials and Research Unit University of Sheffield Sheffield UK.
¹⁰ Patient Representative, Association of Coloproctology of Great Britain and Ireland Patient Liaison Group London UK.
¹¹ Department of Surgery Addenbrooke's Hospital Cambridge UK.

Abstract

Background: Small bowel obstruction is a common surgical emergency, and is associated with high levels of morbidity and mortality across the world. The literature provides little information on the conservatively managed group. The aim of this study was to describe the burden of small bowel obstruction in the UK.

Methods: This prospective cohort study was conducted in 131 acute hospitals in the UK between January and April 2017, delivered by trainee research collaboratives. Adult patients with a diagnosis of mechanical small bowel obstruction were included. The primary outcome was in-hospital mortality. Secondary outcomes included complications, unplanned intensive care admission and readmission within 30 days of discharge. Practice measures, including use of radiological investigations, water soluble contrast, operative and nutritional interventions, were collected.

Results: Of 2341 patients identified, 693 (29·6 per cent) underwent immediate surgery (within 24 h of admission), 500 (21·4 per cent) had delayed surgery after initial conservative management, and 1148 (49·0 per cent) were managed non-operatively. The mortality rate was 6·6 per cent (6·4 per cent for non-operative management, 6·8 per cent for immediate surgery, 6·8 per cent for delayed surgery; P = 0·911). The major complication rate was 14·4 per cent overall, affecting 19·0 per cent in the immediate surgery, 23·6 per cent in the delayed surgery and 7·7 per cent in the non-operative management groups (P < 0·001). Cox regression found hernia or malignant aetiology and malnutrition to be associated with higher rates of death. Malignant aetiology, operative intervention, acute kidney injury and malnutrition were associated with increased risk of major complication.

Conclusion: Small bowel obstruction represents a significant healthcare burden. Patient-level factors such as timing of surgery, acute kidney injury and nutritional status are factors that might be modified to improve outcomes.

Publication types

Observational Study

MeSH terms

Acute Disease
Acute Kidney Injury / epidemiology
Aged
Aged, 80 and over
Conservative Treatment / standards
Cost of Illness
Female
Hospital Mortality
Humans
Intensive Care Units / statistics & numerical data
Intestinal Obstruction / diagnosis
Intestinal Obstruction / etiology
Intestinal Obstruction / mortality*
Intestinal Obstruction / surgery*
Intestine, Small / pathology*
Male
Malnutrition / mortality
Middle Aged
Morbidity
Mortality / trends
Patient Readmission / statistics & numerical data
Postoperative Complications / epidemiology
Prospective Studies
Time Factors
United Kingdom / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding