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Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit
Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group.

2474-9842
924-934
Lee, Matthew J.
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Anderson, Iain
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Hamady, Zaed
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Lewis, Christopher
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Abbott, S.
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Afshar, S.
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Ahmed, T.
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Akhtar, M.
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Ali, A.
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Anderson, D.
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Barker, J.
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Barker, S.
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Blake, L.
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Briggs, C.
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Brown, E.
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Brown, J.
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Brown, L.
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Butler, M.
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Campbell, L.
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Chan, S.
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Chapman, J.
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Chapman, S.
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Cook, T.
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Cooper, S.
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Cotton, D.
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Cox, C.
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Cutting, J.
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Davies, J.
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Davies, T.
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Day, A.
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Dean, S.
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Evans, J.
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Evans, M.
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Farag, S.
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Foster, A.
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Francis, N.
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Geraghty, A.
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Gilbert, A.
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Gill, C.
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Gill, M.
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Green, N.
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Hannay, J.
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Harris, G.
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Harvey, K.
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Hawkins, J.
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Hicks, G.
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Hope, C.
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Hossain, T.
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Jain, R.
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Jones, A.
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Jones, L.
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Kelly, S.
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Kendall, J.
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Khan, M.
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Khan, T.
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King, G.
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Kumar, S.
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Lau, A.
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Lee, K.
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Lim, E.
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Lim, J.
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Liu, D.
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Malik, A.
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Mansour, S.
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Martin, C.
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Martin, J.
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Martin, R.
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Miles, A.
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Mohamed, E.
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Mohamed, I.
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Moore, N.
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Morris, H.
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Moss, J.
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Newton, R.
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Nguyen, K.
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Nguyen, K.
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Nugent, C.
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O'Neill, A.
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Patel, H.
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Phillips, J.
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Powell, A.
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Qureshi, A.
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Rahman, M.
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Rashid, M.
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Rehman, A.
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Richards, E.
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Robinson, A.
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Robinson, D.
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Shah, P.
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Shah, P.
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Sinclair, P.
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Singh, B.
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Singh, S.
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Skinner, A.
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Smith, I.
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Smith, R.
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Stylianides, N.
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Tan, K.
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Taylor, M.
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Thomas, C.
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Thompson, E.
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Turnbull, A.
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Turnbull, J.
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Wade, T.
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Walker, M.
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Walker, N.
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Walker, T.
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Williamson, A.
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Williamson, J.
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Wong, J.
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National Audit of Small Bowel Obstruction Steering Group and National Audit of Small Bowel Obstruction Collaborators
NASBO Steering Group
NASBO Collaborators
West Midlands Research Collaborative
Lee, Matthew J.
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Anderson, Iain
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Hamady, Zaed
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Lewis, Christopher
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Abbott, S.
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Afshar, S.
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Ahmed, T.
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Akhtar, M.
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Ali, A.
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Anderson, D.
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Barker, J.
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Barker, S.
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Blake, L.
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Briggs, C.
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Brown, E.
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Brown, J.
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Brown, L.
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Butler, M.
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Campbell, L.
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Chan, S.
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Chapman, J.
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Chapman, S.
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Cook, T.
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Cooper, S.
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Cotton, D.
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Cox, C.
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Cutting, J.
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Davies, J.
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Davies, T.
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Day, A.
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Dean, S.
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Evans, J.
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Evans, M.
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Farag, S.
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Foster, A.
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Francis, N.
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Geraghty, A.
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Gilbert, A.
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Gill, M.
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Green, N.
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Hannay, J.
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Harris, G.
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Hawkins, J.
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Hicks, G.
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Hope, C.
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Hossain, T.
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Jain, R.
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Jones, A.
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Jones, C.
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Jones, L.
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Kelly, S.
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Kendall, J.
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Khan, M.
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Khan, T.
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King, G.
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Kumar, S.
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Lau, A.
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Lee, K.
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Lim, E.
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Lim, J.
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Malik, A.
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Miles, A.
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Mohamed, I.
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Moore, N.
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Moss, J.
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Newton, R.
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Nguyen, K.
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Nguyen, K.
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Nugent, C.
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O'Neill, A.
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Patel, H.
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Patel, P.
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Patel, R.
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Patel, S.
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Payne, C.
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Pearson, K.
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Phillips, J.
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Powell, A.
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Qureshi, A.
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Rahman, M.
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Rashid, M.
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Rehman, A.
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Richards, E.
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Robinson, A.
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Robinson, D.
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Saunders, M.
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Scott, K.
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Shah, P.
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Shah, P.
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Sharpe, A.
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Sinclair, P.
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Singh, B.
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Singh, S.
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Smith, R.
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Stylianides, N.
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Tan, K.
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Taylor, M.
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Thomas, C.
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Turnbull, J.
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Wade, T.
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Walker, M.
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Walker, N.
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Walker, T.
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West, M. , National Audit of Small Bowel Obstruction Steering Group and National Audit of Small Bowel Obstruction Collaborators, NASBO Steering Group, NASBO Collaborators and West Midlands Research Collaborative (2020) Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit. BJS Open, 4 (5), 924-934. (doi:10.1002/bjs5.50315).

Record type: Article

Abstract

Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group.

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Published date: 1 October 2020
Additional Information: Funding Information: information Bowel Disease Research Foundation Association of Coloproctology of Great Britain and Ireland Association of Surgeons of Great Britain and Ireland Association of Upper Gastrointestinal Surgeons British Association for Parenteral and Enteral Nutrition British Society for Gastroenterology Royal College of Surgeons of England Royal College of Surgeons of Edinburgh Royal College of Anaesthetists British Association for Surgical Oncology National Emergency Laparotomy AuditThis project was supported by the Bowel Disease Research Foundation, Association of Coloproctology of Great Britain and Ireland, Association of Surgeons of Great Britain and Ireland, Association of Upper Gastrointestinal Surgeons, British Association for Parenteral and Enteral Nutrition, British Society for Gastroenterology, Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Royal College of Anaesthetists, British Association for Surgical Oncology, and the National Emergency Laparotomy Audit. Disclosure: The authors declare no conflict of interest. Publisher Copyright: © 2020 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of British Journal of Surgery Society

Identifiers

Local EPrints ID: 474082
URI: http://eprints.soton.ac.uk/id/eprint/474082
DOI: doi:10.1002/bjs5.50315
ISSN: 2474-9842
PURE UUID: 78212d65-97dc-4312-90af-c4bcb641f00e
ORCID for Zaed Hamady: ORCID iD orcid.org/0000-0002-4591-5226
ORCID for M. West: ORCID iD orcid.org/0000-0002-0345-5356

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Date deposited: 10 Feb 2023 18:17
Last modified: 19 Mar 2024 03:03

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Contributors

Author: Matthew J. Lee
Author: Iain Anderson
Author: Zaed Hamady ORCID iD
Author: Christopher Lewis
Author: S. Abbott
Author: S. Afshar
Author: T. Ahmed
Author: M. Akhtar
Author: A. Ali
Author: D. Anderson
Author: J. Barker
Author: S. Barker
Author: L. Blake
Author: C. Briggs
Author: E. Brown
Author: J. Brown
Author: L. Brown
Author: M. Butler
Author: L. Campbell
Author: S. Chan
Author: J. Chapman
Author: S. Chapman
Author: T. Cook
Author: S. Cooper
Author: D. Cotton
Author: C. Cox
Author: J. Cutting
Author: J. Davies
Author: T. Davies
Author: A. Day
Author: S. Dean
Author: J. Evans
Author: M. Evans
Author: S. Farag
Author: A. Foster
Author: N. Francis
Author: A. Geraghty
Author: A. Gilbert
Author: C. Gill
Author: M. Gill
Author: N. Green
Author: J. Hannay
Author: G. Harris
Author: K. Harvey
Author: J. Hawkins
Author: G. Hicks
Author: C. Hope
Author: T. Hossain
Author: R. Jain
Author: A. Jones
Author: C. Jones
Author: L. Jones
Author: S. Kelly
Author: J. Kendall
Author: M. Khan
Author: T. Khan
Author: G. King
Author: S. Kumar
Author: A. Lau
Author: K. Lee
Author: E. Lim
Author: J. Lim
Author: D. Liu
Author: A. Malik
Author: S. Mansour
Author: C. Martin
Author: J. Martin
Author: R. Martin
Author: A. Miles
Author: E. Mohamed
Author: I. Mohamed
Author: N. Moore
Author: H. Morris
Author: J. Moss
Author: R. Newton
Author: K. Nguyen
Author: K. Nguyen
Author: C. Nugent
Author: A. O'Neill
Author: H. Patel
Author: P. Patel
Author: R. Patel
Author: S. Patel
Author: C. Payne
Author: K. Pearson
Author: J. Phillips
Author: A. Powell
Author: A. Qureshi
Author: M. Rahman
Author: M. Rashid
Author: A. Rehman
Author: E. Richards
Author: A. Robinson
Author: D. Robinson
Author: M. Saunders
Author: K. Scott
Author: P. Shah
Author: P. Shah
Author: A. Sharpe
Author: P. Sinclair
Author: B. Singh
Author: S. Singh
Author: A. Skinner
Author: I. Smith
Author: R. Smith
Author: N. Stylianides
Author: K. Tan
Author: M. Taylor
Author: C. Thomas
Author: E. Thompson
Author: R. Thompson
Author: A. Turnbull
Author: J. Turnbull
Author: T. Wade
Author: M. Walker
Author: N. Walker
Author: T. Walker
Author: N. Watson
Author: J. Watt
Author: J. Watts
Author: M. West ORCID iD
Author: G. Williams
Author: R. Williams
Author: A. Williamson
Author: J. Williamson
Author: J. Wilson
Author: J. Wong
Corporate Author: National Audit of Small Bowel Obstruction Steering Group and National Audit of Small Bowel Obstruction Collaborators
Corporate Author: NASBO Steering Group
Corporate Author: NASBO Collaborators
Corporate Author: West Midlands Research Collaborative

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