Operative Timing and Physiologic Predictors of Outcomes in Blunt Small Bowel and Mesenteric Injury.

INTRODUCTION

Blunt small bowel and mesenteric injury (BSBMI) is uncommon and difficult to diagnose early, and delayed surgical intervention for BSBMI has been associated with increased morbidity. However, the relative prognostic contribution of surgical timing compared with physiologic factors such as age and serum lactate level remains unclear. This study aimed to evaluate postoperative outcomes and identify independent predictors of adverse outcomes in surgically managed BSBMI.

METHODS

This 10-y retrospective cohort study included adult patients who underwent surgery for BSBMI at an advanced-level trauma center in central Taiwan from January 2013 to December 2022. Patients with penetrating trauma, nonoperative management, high-grade solid organ injury, or major extra-abdominal injury were excluded to minimize confounding. Outcomes included postoperative morbidity, intensive care unit (ICU) admission, and prolonged hospital length of stay (LOS) (LOS ≥30 d). Multivariable logistic regression was performed to identify independent predictors of each outcome. Model performance and multicollinearity were assessed using standard diagnostic measures.

RESULTS

A total of 67 patients were included, with a median age of 52 y. Traffic-related mechanisms accounted for the majority of injuries. Overall mortality was 7.5%, and postoperative morbidity occurred in 31.3% of patients. Surgical delay ≥8 h was associated with significantly higher morbidity (43.8% versus 20.0%) and a higher rate of prolonged hospital LOS (LOS ≥30 d: 40.6% versus 11.4%). On multivariable analysis, surgical delay ≥8 h independently predicted postoperative morbidity (odds ratio [OR], 3.45, P = 0.036) and prolonged hospital LOS (OR, 5.98, P = 0.025). Increasing age was independently associated with morbidity, ICU admission, and prolonged hospital LOS (all P < 0.05), while higher initial serum lactate levels independently predicted ICU admission (OR, 1.04, P = 0.022) and prolonged hospital LOS (OR, 1.06, P = 0.016). All multivariable models demonstrated acceptable discrimination, with no evidence of multicollinearity.

CONCLUSIONS

In surgically managed BSBMI, delayed operative intervention, older age, and elevated initial serum lactate level were independently associated with adverse postoperative outcomes. These findings suggest that timely surgical decision-making, together with early physiologic risk stratification, may be important in optimizing outcomes for this diagnostically challenging injury.