Ischaemic bowel in the North of England: trends in management approach and patient outcomes

ABSTRACT NUMBER: NESS PRIZE FOR JUNIOR TRAINEES (BELOW ST3)_3

 

AUTHOR
Bertie Marks

MAIN ABSTRACT TEXT

Introduction
Bowel ischaemia is the third most common indication for emergency laparotomy in the UK and is associated with high rates of postoperative morbidity and mortality. This study describes changes in incidence, patient characteristics, management approach and outcomes for patients with bowel ischaemia over a fifteen-year period.

Methods
Data for patients admitted as an emergency, with a diagnosis of bowel ischaemia, to NHS hospitals in the North of England between 2002 and 2016 were collected. This included patient demographics and co-morbidities, operations performed and outcomes. The primary outcome of interest was in-hospital death within 30 days of admission for non-operatively managed patients and 30-day post-operative mortality for those who underwent an operative intervention.

Results
The incidence of bowel ischaemia has increased as a proportion of emergency general surgery admissions by 68% over fifteen years. More patients are undergoing computerised tomography (CT) imaging has (44.0% vs. 70.3%, p<0.001) and more operations are being performed within 48 hours of admission (p<0.001). The number of patients being managed operatively has fallen from 56.7% to 38.7%. Decreased 30-day mortality rates were observed for both operatively (37.5% to 26.7%, p<0.001) and non-operatively (45.7% to 26.8%, p<0.001) managed patients. Mean length of hospital stay has remained relatively unchanged over time.

Conclusion
Ischaemic bowel is becoming increasingly common. Increased usage of CT imaging has likely resulted in decreased rates of operative management due to its ability to accurately characterise intra-abdominal pathology. Improved mortality rates were observed for both operative and non-operative management strategies.