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Observational Study
. 2025 Mar 28;112(4):znaf080.
doi: 10.1093/bjs/znaf080.

Small bowel obstruction outcomes according to compliance with the World Society of Emergency Surgery Bologna guidelines

Lewis J Kaplan  1 , Isidro Martinez-Casas  2 , Shahin Mohseni  3 , Matteo Cimino  4 , Hayato Kurihara  4 , Matthew J Lee  5 , Gary A Bass  1 ; SnapSBO Collaborators
Collaborators, Affiliations
Observational Study

Small bowel obstruction outcomes according to compliance with the World Society of Emergency Surgery Bologna guidelines

Lewis J Kaplan et al. Br J Surg. .

Abstract

Background: Small bowel obstruction (SBO) is a common surgical emergency associated with substantial morbidity, hospital length of stay (LOS), and healthcare cost. The World Society of Emergency Surgery (WSES) Bologna guidelines provide evidence-informed recommendations for managing adhesive SBO, promoting timely surgical intervention (or non-operative management (NOM) when ischaemia, strangulation, or peritonitis are absent). However, guideline adoption and its impact on outcomes remain under studied. Compliance with the Bologna guidelines was evaluated to determine the impact of compliance on outcomes.

Methods: SnapSBO, a prospective, multicentre, time-bound, observational cohort study, captured data on patients with adhesive SBO across diverse healthcare settings and patient populations. Patient care was categorized into: successful NOM, surgery after an unsuccessful appropriate trial of NOM (NOM-T), and direct to surgery (DTS). Compliance with diagnostic, therapeutic, and postoperative Bologna guideline recommendations was assessed as either complete or partial. Primary outcomes included adherence to the Bologna guidelines, LOS, complications, and the incidence of the composite metric 'optimal outcomes' (LOS ≤5 days, discharge without complications, and no readmission within 30 days).

Results: Among 982 patients with adhesive SBO, successful NOM occurred in 561 (57.1%), 224 (22.8%) underwent NOM-T, and 197 (20.1%) proceeded DTS. The mean(s.d.) LOS was 5.3(9.0), 12.9(11.4), and 7.7(8.0) days respectively (P < 0.001). Optimal outcomes were achieved in 61.0%, 16.1%, and 37.6% respectively (P < 0.001) and full guideline compliance was observed in 17.2%, 10.1%, and 0.4% respectively.

Conclusion: Patients with adhesive SBO whose care was aligned with the Bologna guidelines had a shorter LOS and a greater incidence of optimal outcomes. Addressing evidence-to-practice gaps through implementation strategies that consider contextual factors will enhance guideline adoption and patient outcomes.

Plain language summary

Small bowel obstruction happens when the intestine becomes blocked, often due to scar tissue from previous surgery. It is a common reason people are admitted to hospitals for emergency surgery worldwide. Doctors have created clear guidelines (expert advice) on how best to treat this condition to improve patient outcomes. This study looked at whether doctors follow these guidelines and how it affects patient results. Researchers found that hospitals frequently struggle to fully follow the guidelines because they lack necessary resources or due to differences in medical practices. Improving how closely doctors follow these guidelines could help patients recover faster and experience fewer complications.

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Figures

Fig. 1
Fig. 1
Aetiologies of SBO in the study cohort (n = 1737) SBO, small bowel obstruction.
Fig. 2
Fig. 2
Patient flow diagram SBO, small bowel obstruction; CRP, C-reactive protein; DTS, direct to surgery; NOM, non-operative management.
See this image and copyright information in PMC

References

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