EP 704 Time-to-Theatre in Emergency Large Bowel Obstruction: Evaluating a Modifiable System-Level Determinant of Short-Term Outcomes

Abstract Aims Emergency surgery for large bowel obstruction (LBO) is associated with some of the highest morbidity and mortality in general surgery. Unlike trauma and sepsis, LBO lacks a consistently prioritised time-critical pathway, despite clear biological plausibility for harm from delay. This study aims to evaluate the association between time-to-theatre and 30-day mortality in patients undergoing emergency surgery for CT-confirmed large bowel obstruction. Secondary aims are to characterize emergency surgical pathway intervals and assess associations with postoperative morbidity, intensive care admission, and length of stay. Methods A retrospective observational cohort study is being conducted of emergency general surgery admissions with CT-confirmed large bowel obstruction requiring operative intervention between January 2023 and December 2025. Patients managed conservatively are excluded. Data collected include demographics, physiological risk factors, pathology, and key pathway timestamps from hospital arrival to knife-to-skin. The primary outcome is 30-day mortality. Secondary outcomes include intensive care admission, major postoperative complications (Clavien–Dindo ≥III), anastomotic leak, and postoperative length of stay. Multivariable regression analysis will be used to evaluate associations between time-to-theatre and outcomes. Results Data collection is ongoing at the time of submission. The final analysis will describe variation in emergency surgical pathway timelines, operative characteristics, and short-term outcomes for patients undergoing emergency surgery for large bowel obstruction. Conclusions This study examines time-to-theatre as a potentially modifiable system-level determinant of outcome in emergency large bowel obstruction. By defining delay-prone intervals within real-world emergency pathways, the findings aim to inform theatre prioritization, escalation thresholds, and pathway redesign for this high-risk surgical population.