Safety of Delayed Operation for Small Bowel Obstruction: Nationwide Real-World Data Analysis

Area of Science:

• Gastroenterology
• Surgical Outcomes
• Health Services Research

Background:

• Non-operative management (NOM) is common for uncomplicated small bowel obstruction (SBO).
• Failure of NOM can lead to adverse outcomes.
• The optimal duration of NOM before surgery is not well-defined.

Purpose of the Study:

• To determine a safe time window for non-operative management of SBO.
• To identify risks associated with prolonged NOM.
• To inform surgical timing decisions for SBO patients.

Main Methods:

• Retrospective cohort study using the Japanese Diagnosis Procedure Combination (DPC) database (2016-2020).
• Included 11,034 adult patients who underwent surgery for SBO.
• Patients grouped by days from admission to surgery (0-3, 4-7, 8-13, 14-28 days).
• Multivariate logistic regression analyzed surgical timing and outcomes.

Main Results:

• No significant differences in reoperation or in-hospital mortality rates across groups.
• Bowel resection rates significantly increased with NOM duration beyond 3 days (ORs: 1.53-2.19).
• Aspiration pneumonia risk significantly increased with NOM duration beyond 14 days (OR: 1.74).

Conclusions:

• Prolonging non-operative management for SBO beyond 3 days increases the likelihood of bowel resection.
• Extending NOM beyond 14 days elevates the risk of aspiration pneumonia.
• These findings support considering earlier surgical intervention for SBO.