Prevalence and risk factors of mortality and morbidity after operation for adhesive postoperative small bowel obstruction

Abstract 

Background

Many factors are believed to influence the mortality and morbidity after operations for adhesive small bowel obstruction (SBO).

Methods

In a multicenter prospective cohort of 286 patients operated on for adhesive postoperative SBO, we studied the in-hospital and 30-day postdischarge mortality (early mortality) and morbidity as well as long-term mortality using univariate and multivariate analysis.

Results

In the present cohort, with a median follow-up of 41 months and 9% patients lost to follow-up at the end of the study, the prevalence of early postoperative mortality was 3%. All deceased patients were over 75 years old with an American Society of Anesthesiologists (ASA) class ≥III. The prevalence of long-term mortality was 7% with the following independent risk factors: age >75 years old (hazards ratio [HR] 6.6 [95% confidence interval [CI], 2.4–18.1]), medical complications (HR 7.4 [CI, 2.2–24.3]), and a mixed mechanism of obstruction (HR 4.5 [CI, 1.5–13.7]). Prevalence of medical and surgical morbidity was 8% and 6%, respectively. Independent risk factors for medical complications were ASA class ≥III (odds ratio [OR] 16.8 [CI, 2.1–133.1]) and bands (OR 14.1 [CI, 1.8–111.5]) and for the surgical complications the number of obstructive structures ≥10 (OR 8.3 [CI, 1.6–19.7]), a nonresected intestinal wall injury (OR 5.3 [CI, 1.5–18.3]), and intestinal necrosis (OR 5.6 [CI, 1.6–19.7]). Otherwise, 3 patients with “apparent” reversible ischemia developed a postoperative intestinal necrosis followed by 2 reoperations and 1 death.

Conclusion

The early postoperative mortality is strongly linked with the age and the ASA class and the long-term mortality with postoperative complications. More frequent bowel resections might be suggested for patients featuring a number of obstructive structures ≥10 and an intestinal wall injury, especially when associated with a reversible intestinal ischemia.

Keywords: Adhesion, Small intestine, Intestinal obstruction, Bowel resection, Mortality, Morbidity