Initial SBO Management Pathway Drives Deep Surgical Site Infection Occurrence

Authors:
Lewis Kaplan

Body of Abstract:
Background:
SBO is a common emergency general surgical (EGS) condition that is often related to adhesions. The Bologna Guideline outlines three management pathways, but it is not clear how pathway selection influences post-operative surgical site infection (SSI) in those who require operation for adhesive SBO resolution.

Methods:
A multi-national, prospective, observational, time-bound snapshot audit of SBO management was conducted across a 6-month window (SnapSBO; November 1, 2023 – May 31, 2024). Demographics, laboratory, radiology, and operative data were prospectively collected along with hospital length-of-stay (H-LOS), complications (including infections) and outcome. Patients were groups by management pathway (successful non-operative management (NOM), NOM followed by surgery (NOMOR), or immediate OR). Groups were compared using chi-square tests or Fisher’s exact tests for categorical data; significance was assumed for p < 0.05. Results: A total of 1,737 patients with adhesive SBO were assessed across 21 countries. 850 underwent successful NOM, 379 pursued NOMOR, and 508 were managed with OR. There was no difference between operative cohorts in terms of age (NOMOR 65.2±17.3 vs OR 65.5±18.4 years; p = 0.834), or sex (NOMOR 53.6% vs OR 52% Female; p = 0.688). A greater comorbidity burden was present in NOMOR (77.8%) versus OR patients (69.7%; p < 0.001). OR patients demonstrated a higher incidence of intestinal ischemia (NOMOR 22.8% vs OR 33%; p = 0.002). Time to OR was expectedly longer in NOMOR (43.8±30.6 hours vs OR 12.4±15.2 hours; p < 0.001). Similarly, total H-LOS (NOMOR 7.7±8.0 vs OR 12.4±15.2 days; p < 0.001) and post-operative H-LOS (NOMOR 6.6±9.1 vs OR 10.1±10.4 days; p < 0.001) were also significantly longer following a NOM trial. Superficial wound dehiscence (3.9%) and fascial dehiscence (2.6%) were uncommon in the two operative groups. Overall SSI incidence was similar across groups (NOMOR 8.7% vs OR 7.7%; p = 0.578). While overall deep SSI overall frequency was low (3.9%), deep SSI was more frequent in NOMOR (5.5%) compared to OR patients (2.8%, p = 0.035). Conclusions: SBO patients who undergo a trial of NOM before operation seem to incur an elevated risk of post-operative deep SSI, a finding that may reflect time to OR as well as hospital and surgeon factors. The granular elements that underpin this risk merits specific evaluation.