Predictors of Management Outcomes in Pathological Small Bowel Surgical Emergencies: A Prospective Study in a Busy Emergency Unit

Abstract Background: The management of pathological small bowel disorders in the emergency department is challenging, and is linked to higher morbidity and mortality rates. Aim of Study: The aim of this study was to identify the main factors that could help predict the management outcomes in pathological small bowel surgical emergencies (PSBSEs). Patients and Methods: All patients presenting with PSBSEs to the Emergency Unit over a 6-months period were prospec-tively studied. Data about patient-related, assessment-related, pathology-related, and management-related variables; 90-day morbidity; as well as mortality were all recorded. Univariate and multivariate analyses were carried out to identify the predictors of management outcomes in PSBSEs. Results: Our study included 107 patients. The most fre-quently encountered PSBSEs were obstruction and/or stran-gulation (64 cases, 59.8%). Management was operative in 88 cases (82.2%). Overall, 30 cases (28%) developed morbidity, and 7 cases (6.5%) died. In univariate analysis, 14 different factors were associated with a significantly increased risk of morbidity; whereas in multivariate analysis, only 5 factors were found to be significant predictors of 90-day morbidity. The highest odds of morbidity were associated with re-operation [Odds Ratio (OR)=11.2, 95% CI=6.7-18.3, p=0.001] and hemodynamic status [OR=9.7, 95% CI=2.8-21.5, p=0.001]. Conclusion: Constant abdominal pain at presentation, hemodynamic instability, midline surgical incision, operative time >!2 hours, and re-operation were all associated with a significantly increased risk of 90-day morbidity in patients with PSBSEs.