One-year outcomes following operative or non-operative management of adhesional small bowel obstruction
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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One-year outcomes following operative or non-operative management of adhesional small bowel obstruction. / Mortensen, Marie R; Alouda, Mohammad; Bond, Zara; Burcharth, Jakob; Finne, Katrine F; Jensen, Thomas K; Lolle, Ida; Malik, Talha; Ngo-Stuyt, Loan; Nielsen, Liv B J; Olausson, Maria; Skovsen, Anders P; Tolver, Mette A; Smith, Henry G.
I: BJS open, Bind 7, Nr. 5, 05.09.2023.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - One-year outcomes following operative or non-operative management of adhesional small bowel obstruction
AU - Mortensen, Marie R
AU - Alouda, Mohammad
AU - Bond, Zara
AU - Burcharth, Jakob
AU - Finne, Katrine F
AU - Jensen, Thomas K
AU - Lolle, Ida
AU - Malik, Talha
AU - Ngo-Stuyt, Loan
AU - Nielsen, Liv B J
AU - Olausson, Maria
AU - Skovsen, Anders P
AU - Tolver, Mette A
AU - Smith, Henry G
N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.
PY - 2023/9/5
Y1 - 2023/9/5
N2 - BACKGROUND: A trial of initial non-operative management is recommended in stable patients with adhesional small bowel obstruction. However, recent retrospective studies have suggested that early operative management may be of benefit in reducing subsequent recurrences. This study aimed to compare recurrence rates and survival in patients with adhesional small bowel obstruction treated operatively or non-operatively.METHODS: This was a prospective cohort study conducted at six acute hospitals in Denmark, including consecutive patients admitted with adhesional small bowel obstruction over a 4-month interval. Patients were stratified into two groups according to their treatment (operative versus non-operative) and followed up for 1 year after their index admission. Primary outcomes were recurrence of small bowel obstruction and overall survival within 1 year of index admission.RESULTS: A total of 201 patients were included, 118 (58.7 per cent) of whom were treated operatively during their index admission. Patients undergoing operative treatment had significantly better 1-year recurrence-free survival compared with patients managed non-operatively (operative 92.5 per cent versus non-operative 66.6 per cent, P <0.001). However, when the length of index admission was taken into account, patients treated non-operatively spent significantly less time admitted to hospital in the first year (median 3 days non-operative versus 6 days operative, P <0.001). On multivariable analysis, operative treatment was associated with decreased risks of recurrence (HR 0.22 (95 per cent c.i. 0.10-0.48), P <0.001) but an increased all-cause mortality rate (HR 2.48 (95 per cent c.i. 1.13-5.46), P = 0.024).CONCLUSION: Operative treatment of adhesional small bowel obstruction is associated with reduced risks of recurrence but increased risk of death in the first year after admission.REGISTRATION NUMBER: NCT04750811 (http://www.clinicaltrials.gov).prior (registration date: 11 February 2021).
AB - BACKGROUND: A trial of initial non-operative management is recommended in stable patients with adhesional small bowel obstruction. However, recent retrospective studies have suggested that early operative management may be of benefit in reducing subsequent recurrences. This study aimed to compare recurrence rates and survival in patients with adhesional small bowel obstruction treated operatively or non-operatively.METHODS: This was a prospective cohort study conducted at six acute hospitals in Denmark, including consecutive patients admitted with adhesional small bowel obstruction over a 4-month interval. Patients were stratified into two groups according to their treatment (operative versus non-operative) and followed up for 1 year after their index admission. Primary outcomes were recurrence of small bowel obstruction and overall survival within 1 year of index admission.RESULTS: A total of 201 patients were included, 118 (58.7 per cent) of whom were treated operatively during their index admission. Patients undergoing operative treatment had significantly better 1-year recurrence-free survival compared with patients managed non-operatively (operative 92.5 per cent versus non-operative 66.6 per cent, P <0.001). However, when the length of index admission was taken into account, patients treated non-operatively spent significantly less time admitted to hospital in the first year (median 3 days non-operative versus 6 days operative, P <0.001). On multivariable analysis, operative treatment was associated with decreased risks of recurrence (HR 0.22 (95 per cent c.i. 0.10-0.48), P <0.001) but an increased all-cause mortality rate (HR 2.48 (95 per cent c.i. 1.13-5.46), P = 0.024).CONCLUSION: Operative treatment of adhesional small bowel obstruction is associated with reduced risks of recurrence but increased risk of death in the first year after admission.REGISTRATION NUMBER: NCT04750811 (http://www.clinicaltrials.gov).prior (registration date: 11 February 2021).
KW - Humans
KW - Hospitalization
KW - Intestinal Obstruction/etiology
KW - Length of Stay
KW - Prospective Studies
KW - Retrospective Studies
U2 - 10.1093/bjsopen/zrad103
DO - 10.1093/bjsopen/zrad103
M3 - Journal article
C2 - 37837353
VL - 7
JO - BJS open
JF - BJS open
SN - 2474-9842
IS - 5
ER -
ID: 394295327