A Danish study on emergency or urgent surgery for small bowel obstruction in adults: Incidence, causes, administration of antibiotics, and infectious complications

Abstract

BackgroundSmall bowel obstruction is potentially life-threatening; however, the incidence of surgery for small bowel obstruction is unknown, the patient characteristics are poorly described, and the triggers for giving antibiotics with possible influence on complications are unclear. The aims of this study were to fill these gaps to describe the incidence and the characteristics of patients undergoing surgery for small bowel obstruction and to identify triggers for giving antibiotics and the association with postoperative infections. MethodsFrom July 1, 2014, to July 31, 2015, we included adult patients undergoing surgery for small bowel obstruction at 3 hospitals representing one Danish region. We collected information on patient characteristics, diagnosis, antibiotics, and infectious complications until postoperative day 90 and survival until 1 year. ResultsThe 3 hospitals serve a population of 656,353 adults, and treatment is free of charge. A total of 192 patients underwent emergency surgery for small bowel obstruction in the period (incidence: 27/100,000 citizens or 1,200 operations in Denmark annually). The patients with small bowel obstruction had adhesive obstruction (62%), neoplasms (11%), or hernias (7%). A total of 83% received antibiotic prophylaxis, and triggers were preoperative elevated C-reactive protein [odds ratio (95% confidence intervals): 2.49 (1.04–5.98), P = .041] or resection of the bowel [3.10 (1.22–7.89), P = .017]. The incidence of postoperative infections was not reduced among patients receiving antibiotics. ConclusionWe found that 27/100,000 patients undergo surgery for small bowel obstruction in Denmark each year. Adhesive obstruction was the primary reason (62%). A total of 83% received prophylactic antibiotics triggered by elevated C-reactive protein or bowel resection. We found no association between antibiotic use and infectious complications.