Long-term hospital mortality due to small bowel obstruction after major colorectal surgery in a national cohort database.

Purpose: Adhesions following major colorectal surgery can be responsible for bowel obstruction, mostly occurring in the small intestine. Published data for long-term survival following major colorectal surgery complicated with intestinal obstruction are limited. The aim of this study was to identify the mortality rates and mortality risk factors in patients with primary colorectal surgery (PMCS) complicated with surgical small bowel obstruction (SBO).

Methods: This was a retrospective analysis of a prospective national registry of patients who underwent PMCS in 2008.

Results: Of 15,640 patients who underwent PMCS, 2900 required further surgery for SBO with a median follow-up of 42 months (until the end of 2014). Re-hospitalization mortality rate was 10.1%, and 65% of deaths were obstruction-related. No differences were found in SBO incidence between patients who had undergone laparoscopic or open procedures. Hospital mortality was significantly higher in patients who underwent open PMCS compared with those who underwent a laparoscopic procedure (11% vs. 2%, p = 0.0006). Overall 1- and 5-year survival rates in patients who underwent surgical SBO treatment were significantly lower when the initial surgery was an open procedure compared with a laparoscopy (96.8% vs. 99.4% and 86.6% vs. 95.1%, respectively, p = 0.0016). Multivariate analysis revealed that age, sex, a history of diabetes, cancer, and heart disease were mortality risk factors.

Conclusions: The surgical incidence and mortality rate of PMCS complicated with SBO were elevated. Laparoscopy clearly reduced long-term postoperative mortality in patients with and without abdominal adhesions.