Department of Surgery, Zealand University Hospital, Køge.
Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital.
Dan Med J. 2023 Aug 16;70(9):A01230057.
Inter-hospital variation in the management of small bowel obstruction (SBO) has been described in other countries, but the extent to which similar variations exist in Denmark remains unknown. This study aimed to compare the management of SBO between hospitals in Denmark and identify potential areas for improvement METHODS. This was a multicentre prospective study performed at six emergency hospitals. Patients aged ≥ 18 years with a diagnosis of SBO were eligible for inclusion. The primary study endpoints were the proportion of patients undergoing operative versus non-operative management, laparoscopic surgery versus open surgery and the success rate of non-operative management.
A total of 316 patients were included. No differences were noted in diagnostic pathways or operative versus non-operative management. However, variations were noted in compliance with peri-operative care bundles, ranging from 63.2% to 95.8%. The surgical approach also varied, with the use of laparoscopic surgery ranging from 20.7% to 71.0% (p less-than 0.001). Variations were also noted in duration of surgery (63-124 minutes, p less-than 0.001), time to re-introduction of normal diet and length of hospital stay (3-8.5 days, p less-than 0.001). No differences were observed in 30-day or 90-day mortality rates.
The management of SBO in Denmark is relatively standardised. Future efforts should focus on improving adherence to multidisciplinary peri-operative protocols, optimising patient selection for laparoscopic surgery and standardising nutritional therapy.
None.
NCT04750811.
在其他国家已经描述了医院间在小肠梗阻（SBO）管理方面的差异，但丹麦是否存在类似的差异尚不清楚。本研究旨在比较丹麦各医院 SBO 的管理，并确定潜在的改进领域。
这是一项在六家急诊医院进行的多中心前瞻性研究。年龄≥18 岁且诊断为 SBO 的患者符合纳入标准。主要研究终点是接受手术与非手术治疗、腹腔镜手术与开放手术以及非手术治疗成功率的患者比例。
共纳入 316 例患者。在诊断途径或手术与非手术治疗方面未观察到差异。然而，在围手术期护理包的依从性方面存在差异，范围为 63.2%至 95.8%。手术方法也存在差异，腹腔镜手术的使用率为 20.7%至 71.0%（p<0.001）。手术持续时间（63-124 分钟，p<0.001）、正常饮食恢复时间和住院时间（3-8.5 天，p<0.001）也存在差异。30 天或 90 天死亡率无差异。
丹麦 SBO 的管理相对标准化。未来的努力应侧重于提高多学科围手术期方案的依从性，优化腹腔镜手术患者选择，并规范营养治疗。
无。
NCT04750811。
