Risk factors affecting morbidity and mortality following emergency laparotomy for small bowel obstruction: A retrospective cohort study

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.

Keywords: Emergency laparotomy; Morbidity; Mortality; Outcomes; Small bowel obstruction.