Small bowel obstruction outcomes according to compliance with the World Society of Emergency Surgery Bologna guidelines
Lewis J. Kaplan, Isidro Martínez-Casas, Shahin Mohseni, Matteo Cimino, Hayato Kurihara, Matthew J. Lee, Gary Alan Bass, SnapSBO Collaborators, Agron Dogjani, Kastriot Subashi, Klevis Doci, Joana Spaho, Ali Hasan Abdulla, Sara Ahmed, Yusuf Al-Ansari, Mariam AlKooheji, Alaa Marzooq, Khaled Nazzal, Emir Ahmetašević, Zlatan Mehmedović, Maja Kovačević, Jasminka Mujkanović, Peter Svenningsen, Marie Peter Møller, G Olsen, Abeer Aboalazayem, M. Awad, Mahmoud Elfiky, M. Farouk, Mostafa Gad, Basma Magdy, Peep Talving, Edgar Lipping, Edgar Lipping, Sten Saar, Artjom Bahhir, Maarja Talviste, Vincent Dubuisson, Luca Cigagna, Luigi Cayre, Spyridon Christodoulou, Panagiotis Kokoropoulos, Ioannis Margaris, Maria Papadoliopoulou, Theodoros Sidiropoulos, Pantelis Vassiliu, Evangelos Barkolias, Pavlos Georgalis, Theodosios Kantas, Vasiliki Nikolaou, Aristeidis Papadopoulos, Katerina Tata, Stergios Arapoglou, Ioannis Gkoutziotis, Aikaterini Mpratko, Elissavet Symeonidou, Stylianos Kykalos, Nikolaos Machairas, Adam Mylonakis, Panagiotis Sakarellos, Dimitrios Schizas, Michail Vailas, Iraklis Anastasiadis, Parmenion Patias, Koumarelas Konstantinos, Mourtarakos Saradis, Charles Lee, Chloe Spillane, Dylan Viani Walsh, Nadia Walsh, T. N. Walsh, Gabriel Orsi, Andrew Keane, David Kearney, Emma de Sousa, Michael Sugrue, Anne Marie Doyle, Robert Fitzsimmons, Angus Lloyd, Muhammad Qasim, Mashood Ahmed, Taylor Jacoby, Michael Kelly, Shafagh Khodadi, Paul McCormick, Éanna J. Ryan, Mohamed Salama, Helen Heneghan, Cian Davis, Odhran K. Ryan, Seán Martin, Miklosh Bala, Michele Altomare, Stefano Piero Bernardo Cioffi, Andrea Spota, Giada Panagini, Laura Benuzzi, Stefania Cimbanassi, Noemi DiFuccia, S Manfroni
Abstract
BACKGROUND: Small bowel obstruction (SBO) is a common surgical emergency associated with substantial morbidity, hospital length of stay (LOS), and healthcare cost. The World Society of Emergency Surgery (WSES) Bologna guidelines provide evidence-informed recommendations for managing adhesive SBO, promoting timely surgical intervention (or non-operative management (NOM) when ischaemia, strangulation, or peritonitis are absent). However, guideline adoption and its impact on outcomes remain under studied. Compliance with the Bologna guidelines was evaluated to determine the impact of compliance on outcomes. METHODS: SnapSBO, a prospective, multicentre, time-bound, observational cohort study, captured data on patients with adhesive SBO across diverse healthcare settings and patient populations. Patient care was categorized into: successful NOM, surgery after an unsuccessful appropriate trial of NOM (NOM-T), and direct to surgery (DTS). Compliance with diagnostic, therapeutic, and postoperative Bologna guideline recommendations was assessed as either complete or partial. Primary outcomes included adherence to the Bologna guidelines, LOS, complications, and the incidence of the composite metric 'optimal outcomes' (LOS ≤5 days, discharge without complications, and no readmission within 30 days). RESULTS: Among 982 patients with adhesive SBO, successful NOM occurred in 561 (57.1%), 224 (22.8%) underwent NOM-T, and 197 (20.1%) proceeded DTS. The mean(s.d.) LOS was 5.3(9.0), 12.9(11.4), and 7.7(8.0) days respectively (P < 0.001). Optimal outcomes were achieved in 61.0%, 16.1%, and 37.6% respectively (P < 0.001) and full guideline compliance was observed in 17.2%, 10.1%, and 0.4% respectively. CONCLUSION: Patients with adhesive SBO whose care was aligned with the Bologna guidelines had a shorter LOS and a greater incidence of optimal outcomes. Addressing evidence-to-practice gaps through implementation strategies that consider contextual factors will enhance guideline adoption and patient outcomes.