Malnutrition, nutritional interventions and clinical outcomes of patients with acute small bowel obstruction: results from a national, multicentre, prospective audit

Abstract

Objective: The aim of this study was to assess the nutritional status of patients presenting with small bowel obstruction (SBO), along with associated nutritional interventions and clinical outcomes.

Design: Prospective cohort study.

Setting: 131 UK hospitals with acute surgical services.

Participants: 2069 adult patients with a diagnosis of SBO were included in this study. The mean age was 67.0 years and 54.7% were female.

Primary and secondary outcome measures: Primary outcome was in-hospital mortality. Secondary outcomes recorded included: major complications (composite of in-hospital mortality, reoperation, unplanned intensive care admission and 30-day readmission), complications arising from surgery (anastomotic leak, wound dehiscence), infection (pneumonia, surgical site infection, intra-abdominal infection, urinary tract infection, venous catheter infection), cardiac complications, venous thromboembolism and delirium.

Results: Postoperative adhesions were the most common cause of SBO (49.1%). Early surgery (<24 hours postadmission) took place in 30.0% of patients, 22.0% underwent delayed operation and 47.9% were managed non-operatively. Malnutrition as stratified by Nutritional Risk Index was common, with 35.7% at moderate risk and 5.7% at severe risk of malnutrition. Dietitian review occurred in just 36.4% and 55.9% of the moderate and severe risk groups. In the low risk group, 30.3% received nutritional intervention compared with 40.7% in moderate risk group and 62.7% in severe risk group. In comparison to the low risk group, patients who were at severe or moderate risk of malnutrition had 4.2 and 2.4 times higher unadjusted risk of in-hospital mortality, respectively. Propensity-matched analysis found no difference in outcomes based on use or timing of parenteral nutrition.

Conclusions: Malnutrition on admission is associated with worse outcomes in patients with SBO, and marked variation in management of malnutrition was observed. Future trials should focus on identifying effective and cost-effective nutritional interventions in SBO.

Keywords: adult surgery; nutritional support; perioperative care.

Figure 1

Patient inclusion flow chart.

Figure 2

Relationship of admission white cell count to admission albumin.

Figure 3

Relationship of admission white cell count to Nutritional Risk Index.

Figure 4

Dietician review rates. Red bound is 99% CI and blue bound is 95% CI. Average set at the national average rate.

Figure 5

Use of oral supplements. Red bound is 99% CI and blue bound is 95% CI. Average set at the national average rate.

Figure 6

Use of nasogastric (NG)/nasojejunal (NJ) feed. Red bound is 99% CI and blue bound is 95% CI. Average set at the national average rate.

Figure 7

Parental nutrition (PN)/total parental nutrition (TPN) use rates. Red bound is 99% CI and blue bound is 95% CI. Average set at the national average rate.