Long-term hospital mortality due to small bowel obstruction after major colorectal surgery in a national cohort database
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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).
This was a retrospective analysis of a prospective national registry of patients who underwent PMCS in 2008.
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.
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.
KeywordsSmall bowel obstruction Major colorectal surgery Hospital mortality
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.
- 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.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
- 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
- 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
- 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.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
- 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
- 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