Factors predicting need for and delay in surgery in small bowel obstruction

Safe management of small bowel obstruction (SBO) depends on rapid diagnosis. The objective of this study was to determine factors predictive for operation and resulting in operative delay. A retrospective review was done of 1613 patients over 4 years (2003 to 2007) with International Classification of Diseases, 9th Revision codes for SBO. After excluding patients with incomplete clinical data, incorrectly coded, and age younger than 5 years, 872 patients were reviewed. Analysis was done for factors predictive for operation and factors associated with operative delay. Statistics was done using t test, Wilcoxon-rank-sum, and χ(2). Four hundred ninety-four patients (56.6%) underwent surgery for SBO. Three hundred seventy-eight patients (43.4%) were managed nonoperatively. Of factors examined, younger patients (P = 0.001), no previous operation (P < 0.001), and absence of adhesive disease (P < 0.001) were more likely to go to operation. Acquiring a computed tomographic scan (P = 0.029) or radiograph (P < 0.001) were the only factors that increased time to the operating room (OR). Increased time to the OR was associated with a higher incidence of bowel resection. With those with time to OR less than 24 hours, 39 of 325 patients(12%) had bowel resection versus time to OR greater than 24 hours, 23 of 80 patients (29%) required bowel resection. Identifying patients who may safely undergo nonoperative management remains difficult. Delay in operation for SBO places patients at higher risk for bowel resection.