TY - JOUR

T1 - Inter-hospital variation in management of patients with small bowel obstruction in Denmark

AU - Tolver, Mette Astrup

AU - Ærenlund, Mia Prindahl

AU - Azzam, Mahmoud

AU - Bjerke, Trine

AU - Burcharth, Jakob

AU - Dibbern, Christian Bakholdt

AU - Jensen, Thomas Korgaard

AU - Jordhøj, Jens Qvist

AU - Lolle, Ida

AU - Ngo-Stuyt, Loan

AU - Nielsen, Emil Ø

AU - Nielsen, Liv Bjerre Juul

AU - Olausson, Maria

AU - Skovsen, Anders Peter

AU - Smith, Henry George

N1 - Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

PY - 2023/8/16

Y1 - 2023/8/16

N2 - INTRODUCTION: Inter-hospital variation in the management of small bowel obstruction (SBO) has been described in other countries, but the extent to which similar variations exist in Denmark remains unknown. This study aimed to compare the management of SBO between hospitals in Denmark and identify potential areas for improvement METHODS. This was a multicentre prospective study performed at six emergency hospitals. Patients aged ≥ 18 years with a diagnosis of SBO were eligible for inclusion. The primary study endpoints were the proportion of patients undergoing operative versus non-operative management, laparoscopic surgery versus open surgery and the success rate of non-operative management.RESULTS: A total of 316 patients were included. No differences were noted in diagnostic pathways or operative versus non-operative management. However, variations were noted in compliance with peri-operative care bundles, ranging from 63.2% to 95.8%. The surgical approach also varied, with the use of laparoscopic surgery ranging from 20.7% to 71.0% (p less-than 0.001). Variations were also noted in duration of surgery (63-124 minutes, p less-than 0.001), time to re-introduction of normal diet and length of hospital stay (3-8.5 days, p less-than 0.001). No differences were observed in 30-day or 90-day mortality rates.CONCLUSION: The management of SBO in Denmark is relatively standardised. Future efforts should focus on improving adherence to multidisciplinary peri-operative protocols, optimising patient selection for laparoscopic surgery and standardising nutritional therapy.FUNDING: None.TRIAL REGISTRATION: NCT04750811.

AB - INTRODUCTION: Inter-hospital variation in the management of small bowel obstruction (SBO) has been described in other countries, but the extent to which similar variations exist in Denmark remains unknown. This study aimed to compare the management of SBO between hospitals in Denmark and identify potential areas for improvement METHODS. This was a multicentre prospective study performed at six emergency hospitals. Patients aged ≥ 18 years with a diagnosis of SBO were eligible for inclusion. The primary study endpoints were the proportion of patients undergoing operative versus non-operative management, laparoscopic surgery versus open surgery and the success rate of non-operative management.RESULTS: A total of 316 patients were included. No differences were noted in diagnostic pathways or operative versus non-operative management. However, variations were noted in compliance with peri-operative care bundles, ranging from 63.2% to 95.8%. The surgical approach also varied, with the use of laparoscopic surgery ranging from 20.7% to 71.0% (p less-than 0.001). Variations were also noted in duration of surgery (63-124 minutes, p less-than 0.001), time to re-introduction of normal diet and length of hospital stay (3-8.5 days, p less-than 0.001). No differences were observed in 30-day or 90-day mortality rates.CONCLUSION: The management of SBO in Denmark is relatively standardised. Future efforts should focus on improving adherence to multidisciplinary peri-operative protocols, optimising patient selection for laparoscopic surgery and standardising nutritional therapy.FUNDING: None.TRIAL REGISTRATION: NCT04750811.

KW - Humans

KW - Denmark

KW - Hospitals

KW - Intestinal Obstruction/etiology

KW - Length of Stay

KW - Prospective Studies

M3 - Journal article

C2 - 37622641

VL - 70

JO - Danish Medical Journal

JF - Danish Medical Journal

SN - 2245-1919

IS - 9

ER -