A Nationwide Analysis of Outcomes, Healthcare Encounters, and Costs of Small Bowel Obstruction

Small bowel obstruction (SBO) is a prevalent and clinically challenging condition. Surgical interventions may be relatively high-risk for vulnerable populations, like the elderly and underinsured. We investigated the sociodemographic characteristics, clinical outcomes, and hospital characteristics of SBO encounters to better understand risk factors.

We utilized the 2020 National Inpatient Sample database for adults (age ≥ 18 y) with a diagnosis of SBO, identified using International Classification of Diseases, 10th Revision, Clinical Modification codes. International Classification of Diseases, 10th Revision Procedure Coding System codes were used to define the type of management. The primary outcome was mortality. The secondary outcomes were inpatient cost and length of hospital stay.

Among 246,395 patients with SBO, 25,083 (10%) underwent operative management (OM) and 221,312 (90%) underwent nonoperative management (NOM). Among all patients, majority were female (56%), used Medicare (58%), were White (72%), with a mean age of 65. NOM patients were discharged home more often (75% versus 53%, P < 0.001). OM patients experienced more mortality (4.5% versus 1.4%). OM patients were treated at urban teaching hospitals (71% versus 67%, P < 0.001) more often and had shorter lengths of stay (4.2 versus 11.1 d, P < 0.001) with lower inpatient costs ($11,124 versus $35,346, P < 0.001) compared to NOM. In adjusted analyses, patients aged 75-84 had 9.0 times greater odds of mortality (adjusted odds ratio: 9.0, P < 0.001), and OM had 3.3 greater odds of mortality (adjusted odds ratio: 3.3, P < 0.001).

SBO patients undergoing NOM were found to have longer hospital stays and higher inpatient cost, but overall lower odds of mortality compared to their operative counterparts. These findings may help guide decision making regarding SBO management, especially in the elderly population.