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Malnutrition, nutritional interventions and clinical outcomes of patients with acute small bowel obstruction: results from a national, multicentre, prospective audit.
BMJ Open 2019; 9(7):e029235BO

Abstract

OBJECTIVE

The aim of this study was to assess the nutritional status of patients presenting with small bowel obstruction (SBO), along with associated nutritional interventions and clinical outcomes.

DESIGN

Prospective cohort study.

SETTING

131 UK hospitals with acute surgical services.

PARTICIPANTS

2069 adult patients with a diagnosis of SBO were included in this study. The mean age was 67.0 years and 54.7% were female.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome was in-hospital mortality. Secondary outcomes recorded included: major complications (composite of in-hospital mortality, reoperation, unplanned intensive care admission and 30-day readmission), complications arising from surgery (anastomotic leak, wound dehiscence), infection (pneumonia, surgical site infection, intra-abdominal infection, urinary tract infection, venous catheter infection), cardiac complications, venous thromboembolism and delirium.

RESULTS

Postoperative adhesions were the most common cause of SBO (49.1%). Early surgery (<24 hours postadmission) took place in 30.0% of patients, 22.0% underwent delayed operation and 47.9% were managed non-operatively. Malnutrition as stratified by Nutritional Risk Index was common, with 35.7% at moderate risk and 5.7% at severe risk of malnutrition. Dietitian review occurred in just 36.4% and 55.9% of the moderate and severe risk groups. In the low risk group, 30.3% received nutritional intervention compared with 40.7% in moderate risk group and 62.7% in severe risk group. In comparison to the low risk group, patients who were at severe or moderate risk of malnutrition had 4.2 and 2.4 times higher unadjusted risk of in-hospital mortality, respectively. Propensity-matched analysis found no difference in outcomes based on use or timing of parenteral nutrition.

CONCLUSIONS

Malnutrition on admission is associated with worse outcomes in patients with SBO, and marked variation in management of malnutrition was observed. Future trials should focus on identifying effective and cost-effective nutritional interventions in SBO.

Authors+Show Affiliations

Department of General Surgery, Sheffield Teaching Hospitals NHS FT, Sheffield, South Yorkshire, UK.General Surgery, Hull and East Yorkshire Hospitals NHS Trust, Hull, Kingston upon Hull, UK.Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK.Nottingham University Hospitals NHS Trust, Nottingham, UK.ScHARR, University of Sheffield, Sheffield, UK.General Surgery, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK.Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK.Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK.Colorectal Surgery, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31352419

Citation

Lee, Matthew James, et al. "Malnutrition, Nutritional Interventions and Clinical Outcomes of Patients With Acute Small Bowel Obstruction: Results From a National, Multicentre, Prospective Audit." BMJ Open, vol. 9, no. 7, 2019, pp. e029235.
Lee MJ, Sayers AE, Drake TM, et al. Malnutrition, nutritional interventions and clinical outcomes of patients with acute small bowel obstruction: results from a national, multicentre, prospective audit. BMJ Open. 2019;9(7):e029235.
Lee, M. J., Sayers, A. E., Drake, T. M., Singh, P., Bradburn, M., Wilson, T. R., ... Fearnhead, N. S. (2019). Malnutrition, nutritional interventions and clinical outcomes of patients with acute small bowel obstruction: results from a national, multicentre, prospective audit. BMJ Open, 9(7), pp. e029235. doi:10.1136/bmjopen-2019-029235.
Lee MJ, et al. Malnutrition, Nutritional Interventions and Clinical Outcomes of Patients With Acute Small Bowel Obstruction: Results From a National, Multicentre, Prospective Audit. BMJ Open. 2019 Jul 27;9(7):e029235. PubMed PMID: 31352419.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Malnutrition, nutritional interventions and clinical outcomes of patients with acute small bowel obstruction: results from a national, multicentre, prospective audit. AU - Lee,Matthew James, AU - Sayers,Adele E, AU - Drake,Thomas M, AU - Singh,Pritam, AU - Bradburn,Mike, AU - Wilson,Timothy R, AU - Murugananthan,Aravinth, AU - Walsh,Ciaran J, AU - Fearnhead,Nicola S, AU - ,, Y1 - 2019/07/27/ PY - 2019/7/29/entrez PY - 2019/7/29/pubmed PY - 2019/7/29/medline KW - adult surgery KW - nutritional support KW - perioperative care SP - e029235 EP - e029235 JF - BMJ open JO - BMJ Open VL - 9 IS - 7 N2 - OBJECTIVE: The aim of this study was to assess the nutritional status of patients presenting with small bowel obstruction (SBO), along with associated nutritional interventions and clinical outcomes. DESIGN: Prospective cohort study. SETTING: 131 UK hospitals with acute surgical services. PARTICIPANTS: 2069 adult patients with a diagnosis of SBO were included in this study. The mean age was 67.0 years and 54.7% were female. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was in-hospital mortality. Secondary outcomes recorded included: major complications (composite of in-hospital mortality, reoperation, unplanned intensive care admission and 30-day readmission), complications arising from surgery (anastomotic leak, wound dehiscence), infection (pneumonia, surgical site infection, intra-abdominal infection, urinary tract infection, venous catheter infection), cardiac complications, venous thromboembolism and delirium. RESULTS: Postoperative adhesions were the most common cause of SBO (49.1%). Early surgery (<24 hours postadmission) took place in 30.0% of patients, 22.0% underwent delayed operation and 47.9% were managed non-operatively. Malnutrition as stratified by Nutritional Risk Index was common, with 35.7% at moderate risk and 5.7% at severe risk of malnutrition. Dietitian review occurred in just 36.4% and 55.9% of the moderate and severe risk groups. In the low risk group, 30.3% received nutritional intervention compared with 40.7% in moderate risk group and 62.7% in severe risk group. In comparison to the low risk group, patients who were at severe or moderate risk of malnutrition had 4.2 and 2.4 times higher unadjusted risk of in-hospital mortality, respectively. Propensity-matched analysis found no difference in outcomes based on use or timing of parenteral nutrition. CONCLUSIONS: Malnutrition on admission is associated with worse outcomes in patients with SBO, and marked variation in management of malnutrition was observed. Future trials should focus on identifying effective and cost-effective nutritional interventions in SBO. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/31352419/Malnutrition,_nutritional_interventions_and_clinical_outcomes_of_patients_with_acute_small_bowel_obstruction:_results_from_a_national,_multicentre,_prospective_audit L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&amp;pmid=31352419 DB - PRIME DP - Unbound Medicine ER -