title: Risk factors affecting morbidity and mortality following emergency laparotomy for small bowel obstruction: A retrospective cohort study.
abstract: BACKGROUND
  To identify risk factors for increased 30-day morbidity and mortality, using standardized measuring tools for the characterization of complications after emergency surgery for small bowel obstruction.
  
  
  METHODS
  A retrospective cohort study including patients treated with emergency laparotomy for small bowel obstruction at a Copenhagen University Hospital (2009-2013). Complications were evaluated according to the Clavien-Dindo classification.
  
  
  RESULTS
  A total of 323 patients were included. The overall 30-day morbidity and mortality rates were 28% and 13%, respectively. Six covariates were identified as independent risk factors associated with morbidity by multiple logistic regression analysis. The highest odds for morbidity were seen in patients with chronic nephropathy (Odds Ratio [OR] = 3.9; 95% CI 1.3-15.1), and in patients with a daily use of steroids (OR = 3.5; 95% CI 1.2-10.4). Five independent risk factors were associated with increased odds for mortality. Patients with low physical performance (OR = 3.4; 95% CI 1.3-8.2) or metabolic disorders (OR = 3.2; 95% CI 1.2-8.5) had the highest risk of mortality.
  
  
  CONCLUSIONS
  Morbidity and mortality rates were high in this study compared with other studies. Several comorbid conditions were associated with morbidity and mortality. These results may aid the acute care surgeon in identifying patients with a high-risk for postoperative complications and fatal outcomes.
authors.affiliation: Department of Gastroenterology, Surgical Section, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark; Department of Surgery, Zealand University Hospital Køge, Lykkebæksvej 1, 4600 Koege, Denmark. Electronic address: majajeppesen@me.com.
authors.forename: Maja Haunstrup
authors.initials: MH
authors.lastname: Jeppesen
authors.affiliation: Department of Gastroenterology, Surgical Section, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark. Electronic address: m.tolstrup@dadlnet.dk.
authors.forename: Mai-Britt
authors.initials: MB
authors.lastname: Tolstrup
authors.affiliation: Department of Surgery, Zealand University Hospital Køge, Lykkebæksvej 1, 4600 Koege, Denmark. Electronic address: sakw@regionsjaelland.dk.
authors.forename: Sara
authors.initials: S
authors.lastname: Kehlet Watt
authors.affiliation: Department of Surgery, Zealand University Hospital Køge, Lykkebæksvej 1, 4600 Koege, Denmark. Electronic address: igo@regionsjaelland.dk.
authors.forename: Ismail
authors.initials: I
authors.lastname: Gögenur
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery; D007813:Laparotomy / Q000009:adverse effects* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Emergency laparotomy; Morbidity; Mortality; Outcomes; Small bowel obstruction