Operative and non-operative management for intestinal emergencies: findings from a single-centre retrospective cohort study

Alexander Ross Darbyshire*, Ina Kostakis, Paul Meredith, Caroline Kovacs, David Prytherch, Jim Briggs, Simon K. C. Toh

*Corresponding author for this work

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Abstract

Background: Patients with an intestinal emergency who do not have surgery are poorly characterised. This study used electronic healthcare records to provide a rapid insight into the number of patients admitted with an intestinal emergency and compare short-term outcomes for non-operative and operative management.

Methods: A single centre retrospective cohort study was conducted at a tertiary NHS hospital (01/12/2013-31/01/2020). Patients were identified using diagnosis codes for intestinal emergencies, based on the inclusion criteria for the National Emergency Laparotomy Audit. Relevant data was extracted from electronic health care records (n=3 997).

Results: Nearly half of patients admitted with an intestinal emergency received non-operative management (43.7%). Of those who underwent surgery, 63.7% were started laparoscopically. The non-operative group had a shorter hospital (median: 5.4 days vs 8.2 days [started laparoscopically] or 16.8 days [started open]) and fewer unintended intensive care admissions than the surgical group (2.4% vs 8.7% [started laparoscopically] 21.1% [started open]). However, 30-day mortality for non-operative treatment was double that for surgery (22.4% vs 10.1%). 30-day mortality was found to be even higher for non-operative management (50.3%) compared to surgery (19.5%), in a sub-analysis of patients with admission National Early Warning Score ≥4 (n=683).

Conclusion: The proportion of intestinal emergencies who do not have surgery is greater than expected, and it appears that many respond well to non-operative treatment. However, 30-day mortality for nonoperative management was high, and the low number of admissions to intensive care suggests that major invasive treatment was not appropriate for most in this group.
Original languageEnglish
JournalThe Annals of The Royal College of Surgeons of England
Early online date1 Dec 2023
Publication statusEarly online - 1 Dec 2023

Keywords

  • Emergency
  • Laparotomy
  • Laparoscopy
  • EWS
  • Frailty

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