Management of adhesive small bowel obstruction: A distinct paradigm shift in the United States

Kazuhide Matsushima, Andrew Sabour, Caroline Park, Aaron Strumwasser, Kenji Inaba, Demetrios Demetriades

Research output: Contribution to journalArticle

Abstract

BACKGROUND Recent studies show that early operative intervention in patients who fail nonoperative management of adhesive small bowel obstruction (ASBO) is associated with improved outcomes. The purpose of this study was to determine the trend in practice pattern and outcomes of patients with ASBO in the United States. METHODS Data from the National Inpatient Sample data (2003-2013) were extracted for analysis and included patients (age ≥18 years) who were discharged with primary diagnosis codes consistent with ASBO. We analyzed the data to examine changes in mortality and hospital length of stay in addition to any trends in rate and timing of operative interventions. RESULTS During the study period, 1,930,289 patients were identified with the diagnosis of ASBO. Over the course of the study period, the rate of operative intervention declined (46.10-42.07%, p = 0.003), and the timing between admission and operative intervention was significantly shortened (3.09-2.49 days, p < 0.001). In addition, in-hospital mortality rate decreased significantly (5.29-3.77%, p < 0.001). In the multiple logistic regression analysis, the relative risk of mortality decreased by 5.6% per year (odds ratio, 0.944; 95% confidence interval, 0.937-0.951; p < 0.001). Hospital length of stay decreased from 10.39 to 9.06 days (p < 0.001). CONCLUSION Over the last decade, fewer patients with ASBO were managed operatively, whereas those requiring an operation underwent one earlier in their hospitalization. Although further studies are warranted, our results suggest that recent changes in practice pattern may have contributed to improved outcomes. LEVEL OF EVIDENCE Therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)383-391
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume86
Issue number3
DOIs
StatePublished - Mar 1 2019
Externally publishedYes

Fingerprint

Adhesives
Length of Stay
Mortality
Hospital Mortality
Inpatients
Hospitalization
Logistic Models
Odds Ratio
Regression Analysis
Confidence Intervals
Therapeutics

Keywords

  • Adhesive small bowel obstruction
  • management
  • outcome
  • trends

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Management of adhesive small bowel obstruction : A distinct paradigm shift in the United States. / Matsushima, Kazuhide; Sabour, Andrew; Park, Caroline; Strumwasser, Aaron; Inaba, Kenji; Demetriades, Demetrios.

In: Journal of Trauma and Acute Care Surgery, Vol. 86, No. 3, 01.03.2019, p. 383-391.

Research output: Contribution to journalArticle

Matsushima, Kazuhide ; Sabour, Andrew ; Park, Caroline ; Strumwasser, Aaron ; Inaba, Kenji ; Demetriades, Demetrios. / Management of adhesive small bowel obstruction : A distinct paradigm shift in the United States. In: Journal of Trauma and Acute Care Surgery. 2019 ; Vol. 86, No. 3. pp. 383-391.
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