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International Journal of Colorectal Disease

, Volume 34, Issue 2, pp 329–336 | Cite as

Long-term hospital mortality due to small bowel obstruction after major colorectal surgery in a national cohort database

  • Nicolas Michot
  • Jérémy Pasco
  • Urs Giger-Pabst
  • Guillaume Piessen
  • Jean Jacques Duron
  • Ephrem Salamé
  • Leslie Grammatico-Guillon
  • Mehdi OuaïssiEmail author
Original Article
  • 58 Downloads

Abstract

Purpose

Adhesions following major colorectal surgery can be responsible for bowel obstruction, mostly occurring in the small intestine. Published data for long-term survival following major colorectal surgery complicated with intestinal obstruction are limited. The aim of this study was to identify the mortality rates and mortality risk factors in patients with primary colorectal surgery (PMCS) complicated with surgical small bowel obstruction (SBO).

Methods

This was a retrospective analysis of a prospective national registry of patients who underwent PMCS in 2008.

Results

Of 15,640 patients who underwent PMCS, 2900 required further surgery for SBO with a median follow-up of 42 months (until the end of 2014). Re-hospitalization mortality rate was 10.1%, and 65% of deaths were obstruction-related. No differences were found in SBO incidence between patients who had undergone laparoscopic or open procedures. Hospital mortality was significantly higher in patients who underwent open PMCS compared with those who underwent a laparoscopic procedure (11% vs. 2%, p = 0.0006). Overall 1- and 5-year survival rates in patients who underwent surgical SBO treatment were significantly lower when the initial surgery was an open procedure compared with a laparoscopy (96.8% vs. 99.4% and 86.6% vs. 95.1%, respectively, p = 0.0016). Multivariate analysis revealed that age, sex, a history of diabetes, cancer, and heart disease were mortality risk factors.

Conclusions

The surgical incidence and mortality rate of PMCS complicated with SBO were elevated. Laparoscopy clearly reduced long-term postoperative mortality in patients with and without abdominal adhesions.

Keywords

Small bowel obstruction Major colorectal surgery Hospital mortality 

Notes

Compliance with ethical standards

This study was approved by the National Committee of Informatics and Liberty (CNIL) (no. 1813209v1).

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Leung TT, Dixon E, Gill M, Mador BD, Moulton KM, Kaplan GG, MacLean AR (2009) Bowel obstruction following appendectomy: what is the true incidence? Ann Surg 250(1):51–53.  https://doi.org/10.1097/SLA.0b013e3181ad64a7 CrossRefGoogle Scholar
  2. 2.
    ten Broek RP, Issa Y, van Santbrink EJ, Bouvy ND, Kruitwagen RF, Jeekel J, Bakkum EA, Rovers MM, van Goor H (2013) Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ 347:f5588.  https://doi.org/10.1136/bmj.f5588 CrossRefGoogle Scholar
  3. 3.
    Catena F, Di Saverio S, Coccolini F, Ansaloni L, De Simone B, Sartelli M, Van Goor H (2016) Adhesive small bowel adhesions obstruction: evolutions in diagnosis, management and prevention. World J Gastrointest Surg 8(3):222–231.  https://doi.org/10.4240/wjgs.v8.i3.222 CrossRefGoogle Scholar
  4. 4.
    Ouaissi M, Gaujoux S, Veyrie N, Deneve E, Brigand C, Castel B, Duron JJ, Rault A, Slim K, Nocca D (2012) Post-operative adhesions after digestive surgery: their incidence and prevention: review of the literature. J Visc Surg 149(2):e104–e114.  https://doi.org/10.1016/j.jviscsurg.2011.11.006 CrossRefGoogle Scholar
  5. 5.
    Keenan JE, Turley RS, McCoy CC, Migaly J, Shapiro ML, Scarborough JE (2014) Trials of nonoperative management exceeding 3 days are associated with increased morbidity in patients undergoing surgery for uncomplicated adhesive small bowel obstruction. J Trauma Acute Care Surg 76(6):1367–1372.  https://doi.org/10.1097/TA.0000000000000246 CrossRefGoogle Scholar
  6. 6.
    Kothari AN, Liles JL, Holmes CJ, Zapf MA, Blackwell RH, Kliethermes S, Kuo PC, Luchette FA (2015) “Right place at the right time” impacts outcomes for acute intestinal obstruction. Surgery 158(4):1116–1125.  https://doi.org/10.1016/j.surg.2015.06.032 CrossRefGoogle Scholar
  7. 7.
    Duron JJ, du Montcel ST, Berger A, Muscari F, Hennet H, Veyrieres M, Hay JM, French Federation for Surgical R (2008) Prevalence and risk factors of mortality and morbidity after operation for adhesive postoperative small bowel obstruction. Am J Surg 195(6):726–734.  https://doi.org/10.1016/j.amjsurg.2007.04.019 CrossRefGoogle Scholar
  8. 8.
    Jeppesen MH, Tolstrup MB, Kehlet Watt S, Gogenur I (2016) Risk factors affecting morbidity and mortality following emergency laparotomy for small bowel obstruction: a retrospective cohort study. Int J Surg 28:63–68.  https://doi.org/10.1016/j.ijsu.2016.02.059 CrossRefGoogle Scholar
  9. 9.
    Margenthaler JA, Longo WE, Virgo KS, Johnson FE, Grossmann EM, Schifftner TL, Henderson WG, Khuri SF (2006) Risk factors for adverse outcomes following surgery for small bowel obstruction. Ann Surg 243(4):456–464.  https://doi.org/10.1097/01.sla.0000205668.58519.76 CrossRefGoogle Scholar
  10. 10.
    Yamada T, Okabayashi K, Hasegawa H, Tsuruta M, Yoo JH, Seishima R, Kitagawa Y (2016) Meta-analysis of the risk of small bowel obstruction following open or laparoscopic colorectal surgery. Br J Surg 103(5):493–503.  https://doi.org/10.1002/bjs.10105 CrossRefGoogle Scholar
  11. 11.
    Ha GW, Lee MR, Kim JH (2016) Adhesive small bowel obstruction after laparoscopic and open colorectal surgery: a systematic review and meta-analysis. Am J Surg 212(3):527–536.  https://doi.org/10.1016/j.amjsurg.2016.02.019 CrossRefGoogle Scholar
  12. 12.
    Smolarek S, Shalaby M, Paolo Angelucci G, Missori G, Capuano I, Franceschilli L, Quaresima S, Di Lorenzo N, Sileri P (2016) Small-bowel obstruction secondary to adhesions after open or laparoscopic colorectal surgery. JSLS, 20(4).  https://doi.org/10.4293/JSLS.2016.00073
  13. 13.
    Menzies D, Parker M, Hoare R, Knight A (2001) Small bowel obstruction due to postoperative adhesions: treatment patterns and associated costs in 110 hospital admissions. Ann R Coll Surg Engl 83(1):40–46Google Scholar
  14. 14.
    van Goor H (2007) Consequences and complications of peritoneal adhesions. Color Dis 9(Suppl 2):25–34.  https://doi.org/10.1111/j.1463-1318.2007.01358.x CrossRefGoogle Scholar
  15. 15.
    Fevang BT, Fevang J, Lie SA, Soreide O, Svanes K, Viste A (2004) Long-term prognosis after operation for adhesive small bowel obstruction. Ann Surg 240(2):193201–193201.  https://doi.org/10.1097/01.sla.0000132988.50122.de Google Scholar
  16. 16.
    Panis Y, Maggiori L, Caranhac G, Bretagnol F, Vicaut E (2011) Mortality after colorectal cancer surgery: a French survey of more than 84,000 patients. Ann Surg 254(5):738–743; discussion 743-4.  https://doi.org/10.1097/SLA.0b013e31823604ac CrossRefGoogle Scholar
  17. 17.
    Jouan Y, Grammatico-Guillon L, Espitalier F, Cazals X, Francois P, Guillon A (2015) Long-term outcome of severe herpes simplex encephalitis: a population-based observational study. Crit Care 19:345.  https://doi.org/10.1186/s13054-015-1046-y CrossRefGoogle Scholar
  18. 18.
    Sunder S, Grammatico-Guillon L, Baron S, Gaborit C, Bernard-Brunet A, Garot D, Legras A, Prazuck T, Dibon O, Boulain T, Tabone X, Guimard Y, Massot M, Valery A, Rusch E, Bernard L (2015) Clinical and economic outcomes of infective endocarditis. Infect Dis (Lond) 47(2):80–87.  https://doi.org/10.3109/00365548.2014.968608 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Digestive, Oncological, Endocrine, and Hepatic Surgery and Hepatic TransplantationTrousseau Hospital, CHRUChambray les ToursFrance
  2. 2.Regional Unit of Hospital Epidemiology, Data Center, Department of Medical Information for Epidemiology and Health EconomicsFrançois Rabelais UniversityToursFrance
  3. 3.Department of General-, Visceral, and Transplant SurgeryUniversity of MünsterMunsterGermany
  4. 4.Universty Lille, Department of Digestive and Oncological Surgery, Claude Huriez University HospitalLilleFrance
  5. 5.Department of Digestive SurgeryPitié Salpetrière HospitalParisFrance

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