Maja Haunstrup Jeppesen1, Mai-Britt Tolstrup2, Sara Kehlet Watt3, Ismail Gögenur4. 1. Department of Gastroenterology, Surgical Section, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark; Department of Surgery, Zealand University Hospital Køge, Lykkebæksvej 1, 4600 Koege, Denmark. Electronic address: majajeppesen@me.com. 2. Department of Gastroenterology, Surgical Section, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark. Electronic address: m.tolstrup@dadlnet.dk. 3. Department of Surgery, Zealand University Hospital Køge, Lykkebæksvej 1, 4600 Koege, Denmark. Electronic address: sakw@regionsjaelland.dk. 4. Department of Surgery, Zealand University Hospital Køge, Lykkebæksvej 1, 4600 Koege, Denmark. Electronic address: igo@regionsjaelland.dk.
Abstract
INTRODUCTIONS: To identify risk factors for increased 30-day morbidity and mortality, using standardized measuring tools for the characterization of complications after emergency surgery for small bowel obstruction. METHODS: A retrospective cohort study including patients treated with emergency laparotomy for small bowel obstruction at a Copenhagen University Hospital (2009-2013). Complications were evaluated according to the Clavien-Dindo classification. RESULTS: A total of 323 patients were included. The overall 30-day morbidity and mortality rates were 28% and 13%, respectively. Six covariates were identified as independent risk factors associated with morbidity by multiple logistic regression analysis. The highest odds for morbidity were seen in patients with chronic nephropathy (Odds Ratio [OR] = 3.9; 95% CI 1.3-15.1), and in patients with a daily use of steroids (OR = 3.5; 95% CI 1.2-10.4). Five independent risk factors were associated with increased odds for mortality. Patients with low physical performance (OR = 3.4; 95% CI 1.3-8.2) or metabolic disorders (OR = 3.2; 95% CI 1.2-8.5) had the highest risk of mortality. CONCLUSIONS: Morbidity and mortality rates were high in this study compared with other studies. Several comorbid conditions were associated with morbidity and mortality. These results may aid the acute care surgeon in identifying patients with a high-risk for postoperative complications and fatal outcomes.
INTRODUCTIONS: To identify risk factors for increased 30-day morbidity and mortality, using standardized measuring tools for the characterization of complications after emergency surgery for small bowel obstruction. METHODS: A retrospective cohort study including patients treated with emergency laparotomy for small bowel obstruction at a Copenhagen University Hospital (2009-2013). Complications were evaluated according to the Clavien-Dindo classification. RESULTS: A total of 323 patients were included. The overall 30-day morbidity and mortality rates were 28% and 13%, respectively. Six covariates were identified as independent risk factors associated with morbidity by multiple logistic regression analysis. The highest odds for morbidity were seen in patients with chronic nephropathy (Odds Ratio [OR] = 3.9; 95% CI 1.3-15.1), and in patients with a daily use of steroids (OR = 3.5; 95% CI 1.2-10.4). Five independent risk factors were associated with increased odds for mortality. Patients with low physical performance (OR = 3.4; 95% CI 1.3-8.2) or metabolic disorders (OR = 3.2; 95% CI 1.2-8.5) had the highest risk of mortality. CONCLUSIONS: Morbidity and mortality rates were high in this study compared with other studies. Several comorbid conditions were associated with morbidity and mortality. These results may aid the acute care surgeon in identifying patients with a high-risk for postoperative complications and fatal outcomes.
Authors: Matthew C Hernandez; Arianna Birindelli; John L Bruce; Johannes J P Buitendag; Victory Y Kong; Mircea Beuran; Johnathon M Aho; Ionut Negoi; Damian L Clarke; Salomone Di Saverio; Martin D Zielinski Journal: World J Surg Date: 2018-11 Impact factor: 3.352