Abstract

Background: Small bowel obstruction (SBO) is a common surgical emergency associated with substantial morbidity, hospital length of stay (LOS), and healthcare costs. The World Society of Emergency Surgery (WSES) Bologna guidelines provide evidence-informed recommendations for managing adhesive SBO, promoting timely surgical intervention (or non-operative management (NOM) when ischaemia, strangulation, or peritonitis are absent). However, guideline adoption and its impact on outcomes remain understudied. Compliance with the Bologna guidelines was evaluated to assess its effect on outcomes.

Methods: SnapSBO, a prospective, multicentre, time-bound, observational cohort study, captured data on patients with adhesive SBO across diverse healthcare settings and patient populations. Patient care was categorized into: successful NOM, surgery after an unsuccessful appropriate trial of NOM (NOM-T), and direct-to-surgery (DTS). Compliance with diagnostic, therapeutic, and postoperative Bologna guideline recommendations was assessed as either complete or partial. Primary outcomes included adherence to the Bologna guidelines, LOS, complications, and the incidence of the composite metric 'optimal outcomes' (LOS ≤5 days, discharge without complications, and no readmission within 30 days).

Results: Among 982 patients with adhesive SBO, successful NOM occurred in 561 (57.1%), 224 (22.8%) underwent NOM-T, and 197 (20.1%) proceeded to DTS. The mean(s.d.) LOS was 5.3(9.0), 12.9(11.4), and 7.7(8.0) days respectively (P < 0.001). Optimal outcomes were achieved in 61.0%, 16.1%, and 37.6%, respectively (P < 0.001), and full guideline compliance was observed in 17.2%, 10.1%, and 0.4%, respectively.

Conclusion: Patients with adhesive SBO whose care aligned with the Bologna guidelines had shorter LOS and a higher rate of optimal outcomes. Addressing evidence-to-practice gaps by implementing strategies that account for contextual factors will enhance guideline adoption and patient outcomes.

Keywords: Small bowel obstruction (SBO), surgical emergency, hospital length of stay, Bologna guidelines, World Society of Emergency Surgery (WSES)