Morbidity and Mortality Associated with Laparotomy for Small Bowel Obstruction
Abstracts
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Introduction: This study aims to quantify morbidity associated with laparotomy for small bowel obstruction using a validated classification system and to identify factors that are predictive of a poor outcome Methods: Medical records for 172 consecutive patients undergoing laparotomy for small bowel obstruction over a 5 year period were reviewed. Patients with external herniae treated by local incision and nonmechanical obstruction were excluded. Complications were graded according to a classification system proposed by Clavien et al(1). A univariate and multivariate analysis of risk factors predicting morbidity and mortality was undertaken. Results: The cause of obstruction was adhesions in 73% (n=127), cancer in 11% (n=19), herniae in 7% (n=12), Crohns disese 3%, volvulus 3% and other 3%. Cases were divided into those with minor (Type 1) or no complications (51.7%) and those with Type 2,3 or 4 (more serious) complications (48.3%). Comparing the group with serious complications to minor or no complications, there was a significant difference in mean age (69 vs 55 years, p<0.001), cardiorespiratory comorbidity (36% vs 15%, p=0.001), preoperative albumin (34.4 vs 38.8, p<0.001), preoperative length of stay (3.9 vs 2.2 days, p=0.013), total length of stay (18.7 vs 9,4 days, p<0.001), operation time (87.3 vs 67.4 mins, p=0.003), bowel perforation and carcinoma. On multivariate analysis age, preoperative albumin, preoperative length of stay and operation time were independent predictors of outcome. Conclusions: Laparotomy for small bowel obstruction is associated with significant morbidity. A classification system for morbidity helps to identify complications and quantify morbidity. Age, preoperative length of stay and operation time are associated with increased morbidity after laparotomy for small bowel obstruction.This classification system will be useful when comparing the outcome of laparoscopy for bowel obstruction cases to laparotomy. (1)Ref:Clavien et al. Surgery 1992, 111:518-26 |
