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Should Surgical Services Admit Small Bowel Obstructions Managed Non-operatively?

Christopher Thacker1, Claire Lauer1, Kathleen Nealon1

  • 121599Geisinger Medical Center, Danville, PA, USA.

The American Surgeon
|April 9, 2022
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Admitting non-operative small bowel obstruction (SBO) patients to surgical services (SS) significantly reduces length of stay, mortality, and readmissions compared to medicine services (MS). This supports SS admission for SBO management.

Keywords:
admitting servicesmall bowel obstructiontrauma acute care

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Area of Science:

  • Gastroenterology
  • Surgical Outcomes
  • Healthcare Management

Background:

  • Small bowel obstruction (SBO) management has increasingly shifted towards non-operative approaches over the last decade.
  • Previous research on SBO outcomes often focused on operative patients, leaving a gap in understanding non-operative care.
  • This study specifically examines the outcomes of patients with non-operative SBO.

Purpose of the Study:

  • To evaluate the outcomes of non-operative small bowel obstruction (SBO) patients based on their admission service.
  • To compare length of stay, mortality rates, and readmission rates between patients admitted to surgical services (SS) versus medicine services (MS).

Main Methods:

  • A 12-year retrospective cohort study included adult patients admitted with SBO within a single healthcare system.
  • Data from 3278 non-operative SBO patients were analyzed, focusing on clinicodemographic characteristics and admission details.
  • Statistical analyses included student's t-test, chi-square, and multivariable regression to compare outcomes between SS and MS admissions.

Main Results:

  • Admission to a surgical service (SS) was associated with a significantly decreased length of stay (3.4 vs 4.1 days).
  • SS admissions led to lower in-hospital mortality (0.1% vs 2.2%) and reduced 30-day (OR 0.15) and 180-day mortality (OR 0.307).
  • Readmissions within 30 days (OR 0.683) and 180 days (OR 0.54) were also significantly lower for patients admitted to SS.

Conclusions:

  • For non-operative small bowel obstruction (SBO), admission to a surgical service is linked to improved outcomes, including shorter hospital stays and reduced mortality.
  • The findings support the practice of admitting SBO patients to surgical services for potentially better short-term outcomes.
  • Further research is recommended to explore the impact of comorbidities on long-term outcomes in this patient population.