Challenges of Malignant Small Bowel Obstruction – Results of a State Surgical Mortality Dataset

Abstract

Background: Small bowel obstruction is a common acute surgical pathology. Despite the substantial postoperative mortality associated with small bowel obstruction (SBO), there is limited evidence to support clinical decision-making. The purpose of this study was to identify differences in system, patient and operative features in adults who died following operative treatment of malignant versus nonmalignant small bowel obstruction. Methods: Retrospective analysis of adults with SBO who died in hospital while under the care of a surgeon. Data was collected by the Australian and New Zealand Audit of Surgical Mortality from Queensland hospitals between January 2009 and December 2014. Results: 523 patients died post-operatively following surgical treatment of small bowel obstruction over the six-year study period. The most common etiologies were adhesive (41%), malignancy (25%) and hernia (16%). Compared to those with a nonmalignant etiology, patients with malignant SBO were younger (P < 0.001) but had a longer mean pre-operative inpatient admission (P = 0.007), and were more likely to require an anastomosis at the time of operation (P < 0.001). Conclusion: Despite being younger, patients with malignant small bowel obstruction are challenging to manage. Further studies are needed to help surgeons manage patients with malignant small bowel obstruction.