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Determining a multidisciplinary intraoperative strategy in emergency surgery for bowel obstruction and its impact on outcomes

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Abstract

Purpose

Bowel obstruction accounts for around 50% of all emergency laparotomies. A multidisciplinary (MDT) standardized intraoperative model was applied (definitive, palliative, or damage control surgery) to identify patients suitable for a one-step, definitive surgical procedure favoring anastomosis over stoma, when undergoing surgery for bowel obstruction. The objective was to present mortality according to the strategy applied and to compare the rate of laparoscopic interventions and stoma creations to a historic cohort in surgery for bowel obstruction.

Methods

In a retrospective cohort study, we included patients undergoing emergency surgery for bowel obstruction during a 1-year period at two Copenhagen University Hospitals (2019 and 2021). The MDT model consisted of a 30- and 60-min time-out with variables such as functional and hemodynamic status, presence of malignancy, and surgical capabilities (lap/open). Pre-, intra-, and postoperative data were collected to investigate associations to postoperative complications and mortality. Stoma creation rates and laparoscopies were compared to a historic cohort (2009–2013).

Results

Three hundred sixty-nine patients underwent surgery for bowel obstruction. Intraoperative surgical strategy was definitive in 77.0%, palliative in 22.5%, and damage control surgery in 0.5%. Thirty-day mortality was significantly lower in the definitive patient population (4.6%) compared to the palliative population (21.7%) (p < 0.000). Compared to the historic cohort, laparoscopic surgery for bowel obstruction increased from 5.0 to 26.4% during the 10-year time span, the rate of stoma placements was reduced from 12.0 to 6.1%, p 0.014, and the 30-day mortality decreased from 12.9 to 4.6%, p < 0.000.

Conclusion

An intraoperative improvement strategy can address the specific surgical interventions in patients undergoing surgery for bowel obstruction, favoring anastomosis over stoma whenever resection was needed, and help adjust specific postoperative interventions and care pathways in cases of palliative need.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, [MT]. The data are not publicly available due to [restrictions e.g. their containing information that could compromise the privacy of research participants].

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Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Copenhagen University Hospital Hilleroed, Dyrehavevej 29, 3400, Hillerød, Denmark

    Mai-Britt Tolstrup

  2. Department of Gastrointestinal Surgery, Copenhagen University Hospital Hilleroed, Hillerød, Denmark

    Anders Peter Skovsen

  3. Department of Gastrointestinal Surgery, Copenhagen University Hospital Roskilde and Koege, Roskilde, Denmark

    Ismail Gögenur

Authors
  1. Mai-Britt Tolstrup
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  2. Anders Peter Skovsen
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  3. Ismail Gögenur
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Contributions

MT wrote the manuscript with support from APS and IG. All authors have made substantial contributions to the results and analysis and contributed to the final manuscript. All authors have approved the submitted version.

Corresponding author

Correspondence to Mai-Britt Tolstrup.

Ethics declarations

This research was approved by the Capital Region of Denmark/Research and Innovation: ESDH Workzone no. 21000282. There was no requirement for approval by the National Committee on Health Research Ethics.

Competing interests

The authors declare no competing interests.

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Tolstrup, MB., Skovsen, A.P. & Gögenur, I. Determining a multidisciplinary intraoperative strategy in emergency surgery for bowel obstruction and its impact on outcomes. Langenbecks Arch Surg 409, 110 (2024). https://doi.org/10.1007/s00423-024-03292-1

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