TY - JOUR
T1 - Inter-hospital variation in management of patients with small bowel obstruction in Denmark
AU - Tolver, Mette Astrup
AU - Ærenlund, Mia Prindahl
AU - Azzam, Mahmoud
AU - Bjerke, Trine
AU - Burcharth, Jakob
AU - Dibbern, Christian Bakholdt
AU - Jensen, Thomas Korgaard
AU - Jordhøj, Jens Qvist
AU - Lolle, Ida
AU - Ngo-Stuyt, Loan
AU - Nielsen, Emil Ø
AU - Juul Nielsen, Liv Bjerre
AU - Olausson, Maria
AU - Skovsen, Anders Peter
AU - Smith, Henry George
N1 - Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
PY - 2023/8/16
Y1 - 2023/8/16
N2 - INTRODUCTION: Inter-hospital variation in the management of small bowel obstruction (SBO) has been described in other countries, but the extent to which similar variations exist in Denmark remains unknown. This study aimed to compare the management of SBO between hospitals in Denmark and identify potential areas for improvement METHODS. This was a multicentre prospective study performed at six emergency hospitals. Patients aged ≥ 18 years with a diagnosis of SBO were eligible for inclusion. The primary study endpoints were the proportion of patients undergoing operative versus non-operative management, laparoscopic surgery versus open surgery and the success rate of non-operative management.RESULTS: A total of 316 patients were included. No differences were noted in diagnostic pathways or operative versus non-operative management. However, variations were noted in compliance with peri-operative care bundles, ranging from 63.2% to 95.8%. The surgical approach also varied, with the use of laparoscopic surgery ranging from 20.7% to 71.0% (p less-than 0.001). Variations were also noted in duration of surgery (63-124 minutes, p less-than 0.001), time to re-introduction of normal diet and length of hospital stay (3-8.5 days, p less-than 0.001). No differences were observed in 30-day or 90-day mortality rates.CONCLUSION: The management of SBO in Denmark is relatively standardised. Future efforts should focus on improving adherence to multidisciplinary peri-operative protocols, optimising patient selection for laparoscopic surgery and standardising nutritional therapy.FUNDING: None.TRIAL REGISTRATION: NCT04750811.
AB - INTRODUCTION: Inter-hospital variation in the management of small bowel obstruction (SBO) has been described in other countries, but the extent to which similar variations exist in Denmark remains unknown. This study aimed to compare the management of SBO between hospitals in Denmark and identify potential areas for improvement METHODS. This was a multicentre prospective study performed at six emergency hospitals. Patients aged ≥ 18 years with a diagnosis of SBO were eligible for inclusion. The primary study endpoints were the proportion of patients undergoing operative versus non-operative management, laparoscopic surgery versus open surgery and the success rate of non-operative management.RESULTS: A total of 316 patients were included. No differences were noted in diagnostic pathways or operative versus non-operative management. However, variations were noted in compliance with peri-operative care bundles, ranging from 63.2% to 95.8%. The surgical approach also varied, with the use of laparoscopic surgery ranging from 20.7% to 71.0% (p less-than 0.001). Variations were also noted in duration of surgery (63-124 minutes, p less-than 0.001), time to re-introduction of normal diet and length of hospital stay (3-8.5 days, p less-than 0.001). No differences were observed in 30-day or 90-day mortality rates.CONCLUSION: The management of SBO in Denmark is relatively standardised. Future efforts should focus on improving adherence to multidisciplinary peri-operative protocols, optimising patient selection for laparoscopic surgery and standardising nutritional therapy.FUNDING: None.TRIAL REGISTRATION: NCT04750811.
KW - Humans
KW - Denmark
KW - Hospitals
KW - Intestinal Obstruction/etiology
KW - Length of Stay
KW - Prospective Studies
M3 - Article
C2 - 37622641
SN - 2245-1919
VL - 70
JO - Danish medical journal
JF - Danish medical journal
IS - 9
M1 - A01230057
ER -