Complications and Their Association with Mortality Following Emergency Gastrointestinal Surgery-an Observational Study.

PURPOSE: Emergency gastrointestinal surgery is followed by a high risk of major complications and death. This study aimed to investigate which complications showed the strongest association with death following emergency surgery for gastrointestinal obstruction or perforation. METHODS: We retrospectively included adults who had undergone emergency gastrointestinal surgery for radiologically verified obstruction or perforation at three Danish hospitals between 2014 and 2015. The exposure variables comprised 16 predefined Clavien-Dindo-graded complications. Cox regression with delayed entry was used to analyze the association of these complications with 90-day mortality. We adjusted for hospital, age, American Society of Anesthesiologists classification, pre-operative Sepsis-2 score, cardiac comorbidity, renal comorbidity, hypertension, active cancer, bowel obstruction or perforation, and the surgical procedure. Subgroup analyses were done for patients with gastrointestinal obstruction or perforation. RESULTS: Of the 349 included patients, 281 (80.5%) experienced at least one complication. The risk of death was 20.6% (14) for patients with no complications and varied between 21 and 57% for patients with complications. Renal impairment (hazard ratio (HR): 6.8 (95%CI: 3.7-12.4)), arterial thromboembolic events (HR 4.8 (2.3-9.9)), and atrial fibrillation (HR 4.4 (2.8-6.8)) showed the strongest association with 90-day mortality. Atrial fibrillation was the only complication significantly associated with death in patients with gastrointestinal obstruction as well as perforation. CONCLUSION: This study of patients undergoing emergency gastrointestinal surgery revealed that renal impairment, arterial thromboembolic events, and atrial fibrillation had the strongest association with death. Atrial fibrillation may serve as an in-situ marker of patients needing escalation of care.

A Danish study on emergency or urgent surgery for small bowel obstruction in adults: Incidence, causes, administration of antibiotics, and infectious complications.

BACKGROUND: Small bowel obstruction is potentially life-threatening; however, the incidence of surgery for small bowel obstruction is unknown, the patient characteristics are poorly described, and the triggers for giving antibiotics with possible influence on complications are unclear. The aims of this study were to fill these gaps to describe the incidence and the characteristics of patients undergoing surgery for small bowel obstruction and to identify triggers for giving antibiotics and the association with postoperative infections. METHODS: From July 1, 2014, to July 31, 2015, we included adult patients undergoing surgery for small bowel obstruction at 3 hospitals representing one Danish region. We collected information on patient characteristics, diagnosis, antibiotics, and infectious complications until postoperative day 90 and survival until 1 year. RESULTS: The 3 hospitals serve a population of 656,353 adults, and treatment is free of charge. A total of 192 patients underwent emergency surgery for small bowel obstruction in the period (incidence: 27/100,000 citizens or 1,200 operations in Denmark annually). The patients with small bowel obstruction had adhesive obstruction (62%), neoplasms (11%), or hernias (7%). A total of 83% received antibiotic prophylaxis, and triggers were preoperative elevated C-reactive protein [odds ratio (95% confidence intervals): 2.49 (1.04-5.98), P = .041] or resection of the bowel [3.10 (1.22-7.89), P = .017]. The incidence of postoperative infections was not reduced among patients receiving antibiotics. CONCLUSION: We found that 27/100,000 patients undergo surgery for small bowel obstruction in Denmark each year. Adhesive obstruction was the primary reason (62%). A total of 83% received prophylactic antibiotics triggered by elevated C-reactive protein or bowel resection. We found no association between antibiotic use and infectious complications.

Can fecal microbiota transplantation cure irritable bowel syndrome?

AIM: To verify the utility of treatment with fecal microbiota transplantation (FMT) in patients with irritable bowel syndrome (IBS). METHODS: We searched EMBASE, Cochrane Library and PubMed in March, 2017. The reviewed literature was based on two systematic searches in each of the databases. The MeSH terms used were IBS and fecal microbiota transplantation and the abbreviations IBS and FMT. Reference lists from the articles were reviewed to identify additional pertinent articles. RESULTS: A total of six conference abstracts, one case report, one letter to the editor, and one clinical review were included. In the final analysis, treatment of 48 patients was evaluated. Treatment revealed an improvement in 58% of cases. The varying structure of the nine included studies must be taken into consideration. CONCLUSION: Data on FMT and IBS are too limited to draw sufficient conclusions. Standardized double blinded randomized clinical trials need to be carried out to evaluate the effect of FMT on IBS.