Prospective multicentre study of a new bowel obstruction treatment in colorectal surgery: Reduced morbidity and mortality

Autor: Lea M. Dijksman, Anke B. Smits, J.G. Bloemen, D.H. Biesma, W.J.M. Derksen, Milad Fahim
Rok vydání: 2021
Předmět:
medicine.medical_specialty
Time Factors
Colorectal cancer
Prehabilitation
Nutritional Status
Anastomotic Leak
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Crohn Disease
medicine
Humans
Prospective Studies
Mortality
Elective surgery
Digestive System Surgical Procedures
Diverticulitis
Netherlands
business.industry
Mortality rate
Anastomosis
Surgical
Preoperative Exercise
General Medicine
medicine.disease
Combined Modality Therapy
Colorectal surgery
Diet
Surgery
Bowel obstruction
Treatment Outcome
Increased risk
Oncology
Elective Surgical Procedures
Intestinal Perforation
Laxatives
030220 oncology & carcinogenesis
Preoperative Period
030211 gastroenterology & hepatology
Emergencies
Colorectal Neoplasms
business
Colorectal Surgery
Intestinal Obstruction
Cohort study
Zdroj: European Journal of Surgical Oncology. 47:2414-2420
ISSN: 0748-7983
DOI: 10.1016/j.ejso.2021.05.010
Popis: Introduction Bowel obstruction patients are at increased risk of emergency surgery and have poor nutritional and physical conditions. These patients could benefit from prehabilitation and prevention of emergency surgery. This study assessed the effect of a multimodal obstruction treatment for bowel obstruction patients in colorectal surgery on the risk of emergency surgery and postoperative morbidity and mortality. Materials and methods This multicenter observational cohort study included all consecutive bowel obstruction patients who received obstruction treatment (obstruction protocol) in the period 2019–2020 in two Dutch hospitals. Benign and malignant causes of bowel obstruction were included. Treatment consisted of 1. dietary adjustments, 2. postponing surgery for three weeks, 3. laxatives, and 4. prehabilitation. We compared emergency surgery and postoperative morbidity and mortality rates to known rates from the literature. Results Eighty-nine patients were included: obstruction treatment was successful in 77 patients (87%) who underwent elective surgery and unsuccessful in 12 patients (13%) who underwent emergency surgery. Sixty-six (74%) had colorectal cancer, and 22 (25%) had benign disease. Thirty-day mortality of 0% in our study was significantly lower than the national average of 4% in colorectal cancer patients in the Netherlands (p = 0.049). Anastomotic leakage rate was 3%, severe complications (Clavien-Dindo ≥ III) 8%, and bowel perforation 0%. These rates did not differ significantly from rates reported in literature. Conclusion The obstruction treatment prevented emergency surgery in most patients with bowel obstruction and reduced postoperative morbidity and mortality. The obstruction treatment seems to be a safe and efficient alternative to emergency surgery.
Databáze: OpenAIRE
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