Managing Adhesive Small Bowel Obstruction: Immediate Risks and Long-Term Burden in France

To compare short- and long-term outcomes of non-operative (NOM) versus surgical management for adhesive small bowel obstruction (aSBO), focusing on the association between surgical delay, early mortality, and long-term recurrence.

Although NOM is recommended for uncomplicated aSBO, delayed surgery may increase early mortality and long-term recurrence. Population-based evidence simultaneously addressing short- and long-term outcomes remains limited.

We conducted a nationwide retrospective observational cohort study using the French National Health Data System (2015-2024) including adults admitted with a primary diagnosis of aSBO. Management strategy at index admission was the main exposure. The primary outcome was early (≤30-day) mortality according to surgical delay, categorized by days from admission to operation. Secondary outcomes included bowel resection, recurrence, and mortality during recurrent admissions.

Among 71,573 surgically treated episodes, early mortality increased with longer surgical delay, from 3.6% for surgery within 0-1 days to 7.1% after ≥9 days; bowel resection rates rose accordingly (18.0% to 24.5%). In the long-term, recurrence occurred in 23.5% of patients treated non-operatively versus 8.8% of surgically treated patients (subdistribution hazard ratio [sHR], 0.30; 95% CI, 0.29-0.32). Laparoscopic surgery was associated with a further reduction in recurrence (sHR, 0.72; 95% CI, 0.63-0.81). Mortality during recurrent admissions increased when surgery was required.

Delayed surgery for aSBO is associated with higher early mortality and bowel resection rates. Surgical management, particularly laparoscopic, substantially reduces long-term recurrence. Timely operative decision-making is crucial to balance immediate risks with long-term outcomes.