Small bowel obstruction is a common reason for surgical consultation, but little is known about the natural history of small bowel obstruction.
Dr Marcia McGory and colleagues from Los Angeles performed a population-based analysis to evaluate small bowel obstruction frequency, type of operation, and longterm outcomes.
Using the California Inpatient File, the researchers identified all patients admitted in 1997 with a diagnosis of small bowel obstruction.
Patients were excluded if they had a diagnosis of bowel obstruction in the previous 6 years, from 1991 to 1996.
Of the remaining cohort, the natural history of small bowel obstruction over the subsequent 5 years from 1998 to 2002 was analyzed.
Index hospitalization outcomes, such as surgical versus nonsurgical management, length of stay, in-hospital mortality were evaluated.
The researchers also assessed longterm outcomes, including small bowel obstruction readmissions and 1-year mortality.
|81% of surviving patients had no additional small bowel obstruction readmissions|
|Journal of the American College of Surgeons|
The team identified 32,583 patients with an index admission for small bowel obstruction in 1997.
Of these, 24% had surgery during the index admission.
The distribution of surgical procedures was 38% for lysis of adhesions, 38% hernia repair, 18% small bowel resection with lysis of adhesions, and 6% small bowel resection with hernia repair.
The team found that patients who underwent operations during index admission had longer lengths of stay, lower mortality.
These patients also had fewer small bowel obstruction readmissions, and longer time to readmission than patients treated nonsurgically.
Regardless of treatment during the index admission, 81% of surviving patients had no additional small bowel obstruction readmissions over the subsequent 5 years.
Dr McGory's team concludes, “Most of the 32,583 patients requiring admission for index small bowel obstruction in 1997 were treated nonsurgically, and few of these patients were readmitted.”
“This is the first longitudinal population-based analysis of small bowel obstruction evaluating surgical versus nonsurgical management and outcomes, including mortality and readmissions.”