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

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.