Don't Let the Sun Rise on Small Bowel Obstruction Without Surgical Consultation-Redefining Nonoperative Management...

Area of Science:

• Gastroenterology
• Surgical Outcomes
• Healthcare Management

Background:

• Small bowel obstruction (SBO) is a frequent cause of hospitalization, often managed non-operatively (NOM).
• Non-operative management can lead to prolonged hospital stays, readmissions, and increased resource use.
• Early surgical consultation (SC) may enhance efficiency and patient outcomes in SBO cases.

Purpose of the Study:

• To evaluate the impact of an institution-wide intervention (INT) promoting early SC (<1 day) for SBO patients.
• To assess changes in SC rates, small bowel follow-through (SBFT) utilization, length of stay (LOS), readmissions, and costs.

Main Methods:

• Retrospective analysis of SBO patients requiring NOM from January 2021 to June 2023.
• Patients were divided into pre-intervention (pre-INT) and post-intervention (post-INT) groups based on an intervention implemented in July 2022.
• Key outcomes included SC rates, early SC, SBFT utilization, LOS, 30-day readmission rates, and admission costs.

Main Results:

• The post-INT group showed significantly higher SC rates (94.0% vs 83.3%) and increased SBFT utilization (47.0% vs 33.6%).
• Early SC (<1 day) improved significantly in the post-INT group (74.3% vs 65.7%).
• No significant difference in LOS was observed; however, a trend towards decreased 30-day readmissions (7.3% vs 11.0%) and lower direct costs was noted in the post-INT group.

Conclusions:

• Institution-wide interventions effectively increased early surgical involvement for SBO patients.
• The intervention led to improved SC rates and increased SBFT utilization.
• Early surgical consultation demonstrated a positive trend in reducing readmissions and healthcare costs for SBO management.