Outcomes After Surgery for Benign and Malignant Small Bowel Obstruction

Area of Science:

• Gastroenterology
• Surgical Oncology
• Health Services Research

Background:

• Small bowel obstruction (SBO) is common, but outcomes and risk factors for surgery are not well understood.
• Malignant bowel obstruction (MBO) is a subset of SBO with potentially different surgical outcomes.

Purpose of the Study:

• To characterize surgical outcomes for SBO.
• To identify risk factors for complications and mortality in SBO and MBO surgery.

Main Methods:

• Retrospective cohort study using prospectively collected data (7/2012-3/2015).
• Included patients with bowel obstruction diagnosis codes and surgical procedure codes.
• Stratified cases into MBO and benign SBO groups.

Main Results:

• 86 of 2,233 patients had MBO (3.9%).
• MBO patients had higher adjusted mortality (14.5% vs. 5.0%) and complication rates (32.2% vs. 27.0%).
• Mortality risk factors included disseminated cancer, older age, ASA IV/V, cirrhosis, ascites, infection, low albumin/hematocrit, and bowel resection.

Conclusions:

• Surgery for SBO has significant morbidity and mortality, especially for MBO.
• Identified risk factors can inform clinical decision-making for MBO surgical recommendations.