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Related Concept Videos

Inflammatory Bowel Disease V: Surgical Management01:21

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Related Experiment Video

Updated: Aug 11, 2025

Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
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Geographic Variation in Operative Management of Adhesive Small Bowel Obstruction.

Samuel P Carmichael1, David M Kline2, Nathan T Mowery1

  • 1Department of Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.

The Journal of Surgical Research
|February 8, 2023
PubMed
Summary

Geographic variation exists in surgical management for adhesive small bowel obstruction (aSBO). Operative intervention for aSBO reduces readmission rates, highlighting a need for standardized guidelines.

Keywords:
Abdominal adhesionsBowel obstructionEmergency general surgeryNonoperative management

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Area of Science:

  • General Surgery
  • Health Services Research
  • Surgical Outcomes

Background:

  • Surgical management for adhesive small bowel obstruction (aSBO) lacks national standardization.
  • Geographic variations in healthcare delivery are well-documented but understudied for aSBO.

Purpose of the Study:

  • To investigate geographic variation in the surgical management of adhesive small bowel obstruction (aSBO) across the United States.
  • To identify predictors of operative intervention for aSBO and the impact of surgery on patient outcomes.

Main Methods:

  • Retrospective analysis of a national commercial insurance claims database (2017-2019).
  • Bayesian spatial rates Poisson regression for state-level variation in operative intervention rates.
  • Logistic regression for individual-level predictors and outcomes.

Main Results:

  • Significant geographic variation in aSBO operative intervention rates was observed, with higher rates in Missouri and lower rates in Florida.
  • Male sex and older age were negatively associated with operative intervention.
  • Prior aSBO admission increased representation odds five-fold; operative intervention reduced subsequent readmission by 77%.

Conclusions:

  • Surgical management of aSBO demonstrates significant geographic variation within the USA.
  • Operative intervention for aSBO is associated with reduced subsequent representation.
  • Standardized guidelines for emergency general surgery, including aSBO, are critically needed.