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Area of Science:

  • Gastroenterology
  • Surgical Outcomes
  • Public Health

Background:

  • Non-operative management (NOM) is standard for uncomplicated adhesive small bowel obstruction (aSBO).
  • Limited population-based data exist on the simultaneous short- and long-term effects of delayed surgery for aSBO.
  • Delayed surgical intervention may increase mortality and recurrence rates.

Purpose of the Study:

  • To compare short- and long-term outcomes of non-operative versus surgical management for aSBO.
  • To investigate the impact of surgical delay on early mortality and long-term recurrence in aSBO patients.
  • To evaluate the association between management strategy and outcomes in a large national cohort.

Main Methods:

  • Nationwide retrospective observational cohort study using the French National Health Data System (2015-2024).
  • Inclusion of adult patients with a primary diagnosis of aSBO.
  • Primary outcome: early (≤30-day) mortality stratified by surgical delay; Secondary outcomes: bowel resection, recurrence, and mortality during recurrent admissions.

Main Results:

  • Early mortality increased with surgical delay, from 3.6% (0-1 days) to 7.1% (≥9 days) among 71,573 surgically treated episodes.
  • Bowel resection rates rose from 18.0% to 24.5% with delayed surgery.
  • Long-term recurrence was 23.5% with NOM vs. 8.8% with surgery (sHR, 0.30). Laparoscopic surgery further reduced recurrence (sHR, 0.72).

Conclusions:

  • Delayed surgery for aSBO is linked to increased early mortality and bowel resection rates.
  • Surgical management, particularly laparoscopic approaches, significantly decreases long-term recurrence.
  • Prompt surgical decision-making is essential for optimizing both immediate risks and long-term patient outcomes in aSBO.