Evaluation of the Management Strategies for Adhesive Small-Bowel Obstruction

The management of adhesive small-bowel obstruction (aSBO) continues to have wide variation, with no one management strategy accepted as the optimal. The first objective was to evaluate the methods of management and the variations in the management of aSBO at our institution and evaluate the outcomes of those management strategies. The second objective was to compare our outcomes to those of a published study by which patients were managed using an institutional protocol for aSBO.

A retrospective review of 465 patient encounters with a diagnosis of small-bowel obstruction from January 2019 to December 2020 was done. Data regarding implementation of nasogastric decompression, oral contrast administration, operative intervention, time to operation, length of stay, readmission, and mortality were collected and analyzed. These data were compared to a published protocol with outcomes of hospital length of stay, time to operation, and mortality. For comparative purposes, patient encounters were separated into one of four groups based on the administration of oral contrast and surgical intervention.

Among patients managed at our institution without protocol, 77% had nasogastric decompression, and 49% had oral contrast administration, with an average time to contrast of 34 hs. The operative rate was 23% at our institution without protocol compared to 56% at the institution with protocol. A decreased time to surgery was demonstrated in patients managed per institution protocol. Hospital length of stay was longer in three of four of the patient subgroups at the institution with protocol compared to our institution without protocol; however, a greater admission range was observed in patients managed without protocol. Overall mortality was less in patients managed without protocol at 1.3% compared to 2.9% in patients managed per protocol.

The implementation of clinical practice guidelines for aSBO could improve the uniformity of patient care, implement data-driven methods such as contrast administration, time to contrast administration, and decrease the length of time to operating room when patients are initially managed nonoperatively.