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Trends in Management of Index Adhesive Small Bowel Obstruction in Children
Utsav M Patwardhan1, Gretchen M Floan1, Richard Y Calvo2
1Department of General Surgery, Naval Medical Center San Diego, San Diego, California.
Insights
Most children with adhesive small bowel obstruction (ASBO) undergo operative management (OPM). Late surgery increases hospital stay and complications, but does not affect bowel resection or mortality rates.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Health Services Research
Background:
- Adhesive small bowel obstruction (ASBO) is a common surgical condition in children.
- Management strategies for pediatric ASBO range from nonoperative care to operative intervention.
- Understanding practice patterns and outcomes is crucial for optimizing pediatric ASBO care.
Purpose of the Study:
- To analyze practice patterns for nonoperative versus operative management (OPM) in children with index adhesive small bowel obstruction (ASBO).
- To compare surgical outcomes between different management strategies for pediatric ASBO.
- To identify factors influencing the choice between nonoperative and operative approaches.
Main Methods:
- Utilized a California statewide health discharge database (2007-2020) to identify pediatric patients (<18 years) with index ASBO.
- Evaluated initial management patterns: nonoperative vs. OPM, and early (≤3 days) vs. late (>3 days) surgery.
- Assessed secondary outcomes including hospital characteristics, patient demographics, and postoperative complications.
Main Results:
- Operative management (OPM) was used in 85% of 2297 identified pediatric ASBO cases.
- Late surgery (>3 days) was associated with longer length of stay, increased infectious complications, and higher total parenteral nutrition use compared to early surgery.
- No significant differences were observed in bowel resection rates or mortality between early and late surgical management.
Conclusions:
- A high rate of operative management (OPM) for index ASBO in children, particularly newborns and toddlers, was observed.
- While late surgery increased length of stay and infectious complications, it did not impact bowel resection or mortality.
- Further research is needed to refine management strategies and optimize outcomes for pediatric ASBO.
Introduction:
To examine practice patterns and surgical outcomes of nonoperative versus operative management (OPM) of children presenting with an index adhesive small bowel obstruction (ASBO).
Methods:
A California statewide health discharge database was used to identify children (<18 y old) with an index ASBO from 2007 to 2020. The primary study outcome was evaluating initial management patterns (nonoperative versus OPM and early [≤3 d] versus late surgery [>3 d]) of ASBO. Secondary outcomes were hospital characteristics, patient demographics, and postoperative complications.
Results:
Of the 2297 patients identified, 1948 (85%) underwent OPM for ASBO during the index admission. Of these, 14.7% underwent early surgery within 3 d. Teaching hospitals had higher operative intervention than nonteaching centers (87.1% versus 83.7%, P = 0.034). OPM was the highest in 0-5-year-olds compared to other ages (89% versus 82%, P < 0.001). In comparison to early surgery, late surgery was associated with longer length of stay (early 7[interquartile range 5-10], late 9[interquartile range 6-17], P < 0.001), increased infectious complications (16.4% versus 9.8%, P = 0.004), and greater use of total parenteral nutrition (28.0% versus 14.3%, P = 0.001); there was no difference in bowel resection (21% versus 18%, P = 0.102) or mortality (P = 0.423).
Conclusions:
Our pediatric study demonstrated a high rate of OPM for index ASBO, especially in newborns and toddlers. Although operative intervention, especially late surgery, was associated with increased length of stay, increased infectious complications, and increased total parenteral nutrition use, the rates of bowel resection and mortality did not differ by management strategy. These trends need to be further evaluated to optimize outcomes.
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