Optimal Time to Surgery for Small Bowel Obstruction: A Risk Adjusted Analysis Utilizing the Nationwide Inpatient...

Area of Science:

• General Surgery
• Gastrointestinal Surgery
• Surgical Outcomes Research

Background:

• Small bowel obstruction (SBO) management presents challenges for general surgeons.
• While most SBO cases are treated conservatively, optimal surgical timing remains uncertain.
• This study evaluates the ideal timeframe for surgical intervention following SBO diagnosis.

Purpose of the Study:

• To determine the optimal timing for operative intervention in patients with small bowel obstruction (SBO).
• To analyze the association between preoperative length of stay (LOS) and patient outcomes.
• To identify risk-adjusted postoperative outcomes based on surgical timing.

Main Methods:

• Retrospective analysis of the Nationwide Inpatient Sample (2006-2015).
• Identification of SBO surgeries using ICD-9-CM codes.
• Stratification into groups based on days from admission to surgery, with propensity score and multivariate regression analyses.

Main Results:

• Analysis of 92,807 non-elective SBO surgeries revealed an overall mortality rate of 4.7%.
• Surgery between postoperative days 3-5 showed the lowest mortality.
• Delayed intervention (≥6 days) decreased cardiac and pulmonary complications, while 3-5 days LOS increased wound and procedural complications.

Conclusions:

• A preoperative length of stay (LOS) of 3-5 days is associated with reduced mortality risk.
• Increasing preoperative LOS correlates with decreased cardiopulmonary complications.
• However, the 3-5 day window also presents increased risks for procedural and wound complications, suggesting technical challenges.