Malnutrition, nutritional interventions and clinical outcomes of patients with acute small bowel obstruction: results from a national, multicentre, prospective audit

Matthew James Lee; Adele E Sayers; Thomas M Drake; Pritam Singh; Mike Bradburn; Timothy R Wilson; Aravinth Murugananthan; Ciaran J Walsh; Nicola S Fearnhead; NASBO Steering Group and NASBO Collaborators

doi:10.1136/bmjopen-2019-029235

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. doi: 10.1136/bmjopen-2019-029235.

Authors

Matthew James Lee¹, Adele E Sayers², Thomas M Drake³, Pritam Singh⁴, Mike Bradburn⁵, Timothy R Wilson⁶, Aravinth Murugananthan⁷, Ciaran J Walsh⁸, Nicola S Fearnhead⁹; NASBO Steering Group and NASBO Collaborators

Collaborators

NASBO Steering Group and NASBO Collaborators:
John Abercrombie, Austin Acheson, Derek Alderson, Iain Anderson, Simon Bach, Michael Davies, Zaed Hamady, Daniel Hind, Marianne Hollyman, Sarah Hare, Ellen Lee, John Northover, Christopher Lewis, Paul Marriott, Nick Maynard, Malcolm Mcfall, David Murray, Gillian Tierney, Azmina Verjee, Jonathan Wild, Abbott S, Abdulaal Y, Afshar S, Ah-Chuen J, Ahmed T, Akhtar M, Akram F, Aldred E, Ali A, Aly M, Amajuoyi A, Amin V, Anderson D, Anderson O, Andreou A, Ansari A, Appleton S, Ardley R, Arshad F, Ashour O, Asour A, Athem A, Athersmith M, Ayoub F, Azeem H, Azhar B, Badenoch T, Baillie C, Bandyopadhyay D, Barker J, Barker S, Barkham B, Baron R, Barrie J, Barry-Yarrow E, Bashir G, Battersby N, Bazoua G, Behar N, Bellam S, Berger C, Bhandari S, Bhasin S, Biggs S, Bisset C, Blake L, Blencowe N, Boam T, Boddy A, Boereboom C, Bogdan M, Bogle R, Bohra P, Boland M, Bolkan H, Borg C, Boulton R, Bouras G, Boyer M, Boyle J, Branagan G, Brewer H, Briggs C, Broadhurst J, Brown E, Brown J, Brown L, Brown O, Burns K, Butcher K, Butler M, Byrne B, Campbell L, Capper C, Cartmell M, Cash T, Chan S, Chandratreya N, Chapman J, Chapman S, Charalabopoulos A, Cheek C, Chok S, Choong W, Chow M, Chowdhury J, Coe P, Conaghan P, Conn G, Cook N, Cook T, Cooper S, Cornish J, Cotton D, Cox C, Coyne P, Crook R, Crozier J, Cuffolo G, Cunha P, Curtis N, Cutting J, Da Costa K, Da Silva L, Das B, Davenport M, Davies J, Davies T, Day A, Dayal S, Dean S, Demetriou G, Dengu F, Dennis R, Dent H, Dent P, Deputy M, Devoto L, Di Benedetto G, Dindyal S, Donnelly E, Doody P, Douka E, Downham C, Dowson H, Edent H, Edgerton K, Ekpete N, El Farran M, Elamin O, Eljaafari M, Elsaid N, El-Sharif M, Evans J, Evans M, Ewe R, Ewing A, Exarchou K, Fallaize R, Faoury M, Farag S, Farinella E, Faulkner G, Ferguson H, Fisher O, Fletcher J, Forouzanfar A, Foster A, Fox R, Francis N, Fretwell V, Fung D, Gammeri E, Garnham J, Geraghty A, Gilbert A, Gill C, Gill M, Gillespie M, Giordano P, Glasbey J, Goh M, Golder A, Green N, Gregoir T, Grey T, Groundwater E, Grove T, Growcott S, Gunasekaran S, Habib H, Haddow J, Halahakoon V, Halkias C, Hall C, Hampson A, Hancock L, Hanna T, Hannay J, Harikrishnan A, Harries R, Harris G, Hartley J, Harvey K, Hawkin P, Hawkins J, Healy R, Heard R, Heartshorne R, Heller S, Hendra L, Herrod P, Heywood N, Hicks G, Hobson B, Holtham S, Holtham S, Hope C, Hopley P, Hossain T, Hossaini S, Howse F, Hubbard T, Humphreys A, Ikram H, Ioannis M, Iqbal M, Iqbal N, Jain R, Jatania J, Jenkinson P, Jokhan S, Jones A, Jones C, Jones L, Joshi H, Joshi K, Joy M, Jull P, Kakaniaris G, Kakaniaris G, Kallam R, Kane E, Kang P, Kanitkar R, Kauser S, Kazmi F, Kedrzycki M, Kelly S, Kendall J, Khan M, Khan T, King G, Kisiel A, Kitsis C, Kolawole I, Korambayil S, Kosasih S, Kosti A, Kotb A, Kouris S, Kshatriya K, Kumar S, Lafaurie G, Lal R, Lau A, Lazim T, Lazim T, Lazzaro A, Lee K, Lefroy R, Leinhardt D, Leinhardt D, Lennon H, Leong K, Levy B, Lim E, Lim J, Lindley S, Liu D, Lloyd P, Locker D, Lockwood S, Lowe C, Lund J, Lunevicius R, Lunt A, Lutfi S, Luther A, Luwemba S, Mahankali-Rao P, Mahroof S, Mai D, Majid S, Malik A, Malik K, Mann K, Mansour S, Manu N, Mapara R, Martin C, Martin J, Martin R, Mason C, Massey L, Mathias J, Mathur P, Maude K, Mcarthur D, Mccain S, Mccluney S, Mcilroy B, Mckay S, Mckinley N, Mcnair A, Mcwhirter D, Mekhail P, Mellor K, Merchant J, Merker L, Messenger D, Miles A, Mir S, Mishra A, Mistry P, Miu V, Moat M, Mockford K, Mohamed E, Mohamed I, Mondragon-Pritchard M, Moore N, Moretti L, Morris H, Morrison T, Morrison-Jones V, Moss J, Moug S, Mountford D, Moynihan R, Muhammad K, Muldoon-Smith D, Mulholland J, Mullan M, Murgitroyd E, Murugaiyan K, Myers A, Mykoniatis I, Nana G, Nash T, Nassar A, Newton R, Ng C, Ng P, Ng P, Nguyen K, Nguyen K, Nicholas F, Noor M, Nowers J, Nugent C, Nunn A, Nunn R, Obeid N, O'callaghan J, O'hara R, Oke O, Olivier J, O'neill A, O'neill S, Osei-Bordom D, Osgood L, Panagiotopoulos S, Panchasara B, Parks R, Patel H, Patel P, Patel R, Patel S, Pawelec K, Payne C, Pearson K, Perin G, Peristerakis I, Petronio B, Phelan L, Phillips J, Pisaneschi C, Pitt J, Plunkett-Reed K, Ponchietti L, Pouzi A, Pouzi M, Powell A, Powell-Chandler A, Pranesh N, Proctor V, Pywell S, Qureshi A, Qureshi N, Rahman M, Rai Z, Ramcharan S, Rangarajan K, Rashid M, Reader H, Rehman A, Rehman S, Rengifo C, Richards E, Richardson N, Robinson A, Robinson D, Rossi B, Rutherford F, Sadien I, Saghir T, Sahnan K, Salahia G, Sarveswaran J, Saunders M, Scott B, Scott K, Seager A, Seal S, Sezen E, Shaban F, Shah P, Shah P, Shahmohammadi M, Shamsiddinova A, Shankar S, Sharpe A, Shatkar V, Sheel A, Shields T, Shinkwin M, Shurmer J, Siddika A, Siddiqui S, Simson R, Sinclair P, Singh B, Singh S, Sivaraj J, Skaife P, Skelly B, Skinner A, Slim N, Smart C, Smart N, Smith F, Smith I, Smith R, Spence G, Sreedhar A, Steinke J, Stevenson L, Stewart-Parker E, Stott M, Stubbs B, Stubbs B, Stylianides N, Subramonia S, Swinkin M, Swinscoe M, Symons N, Tahir W, Taj T, Takacs K, Tam J, Tan K, Tani S, Tanner N, Tao D, Taylor M, Thava B, Thippeswamy K, Thomas C, Thompson E, Thompson R, Thompson-Reil C, Thorn C, Tongo F, Toth G, Turnbull A, Turnbull J, Valero C, Van Boxel G, Varcada M, Venn M, Ventham N, Venza M, Vimalachandran D, Virlos I, Wade T, Wafi A, Waite K, Walker M, Walker N, Walker T, Walsh U, Wardle S, Warner R, Watfah J, Watson N, Watt J, Watts J, Wayman J, Weegenaar C, West H, West M, Whitehurst L, Whyler M, Wiggans M, Wijeyekoon S, Williams G, Williams R, Williamson A, Williamson J, Wilson J, Winter A, Wolpert L, Wong J, Yeap E, Yeong T, Zaman S, Zappa B, Zosimas D, West Midlands Research Collaborative

Affiliations

¹ Department of General Surgery, Sheffield Teaching Hospitals NHS FT, Sheffield, South Yorkshire, UK.
² General Surgery, Hull and East Yorkshire Hospitals NHS Trust, Hull, Kingston upon Hull, UK.
³ Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK.
⁴ Nottingham University Hospitals NHS Trust, Nottingham, UK.
⁵ ScHARR, University of Sheffield, Sheffield, UK.
⁶ General Surgery, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK.
⁷ Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK.
⁸ Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK.
⁹ Colorectal Surgery, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK.

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.

Keywords: adult surgery; nutritional support; perioperative care.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Acute Disease
Aged
Aged, 80 and over
Clinical Audit
Female
Hospital Mortality
Humans
Intestinal Obstruction / complications*
Intestine, Small*
Male
Malnutrition / etiology*
Malnutrition / mortality
Malnutrition / therapy*
Middle Aged
Nutritional Status*
Parenteral Nutrition*
Prospective Studies

Abstract

Publication types

MeSH terms

Grants and funding