title: Readmission for small-bowel obstruction in the early postoperative period: etiology and outcome.
abstract: OBJECTIVE
  To determine the frequency of readmission for early postoperative small-bowel obstruction (SBO), to highlight factors that may predispose to this condition, to define the risks of strangulation and to compare the immediate and long-term risks and benefits of operative versus nonoperative treatment.
  
  
  METHODS
  A chart review.
  
  
  METHODS
  The Sir Mortimer B. Davis-Jewish General Hospital, a university-affiliated teaching hospital in Montreal.
  
  
  METHODS
  Out of a total of 1001 cases of SBO in 552 patients, 30 patients were readmitted within 50 days of a previous laparotomy with the diagnosis of SBO.
  
  
  METHODS
  Selective nonoperative management and exploratory laparotomy.
  
  
  METHODS
  The value of nonoperative management and need for operation.
  
  
  RESULTS
  Adhesions were the cause of the obstruction in most cases (24); other causes were Crohn's disease (2), hernia (1), malignant neoplasm (1) and a combination of adhesions and malignant disease (2). Thirteen (43%) of the procedures preceding the obstruction were primary small-bowel operations. There was only 1 episode of strangulated bowel. Of the patients readmitted for SBO, 7 (23%) were treated operatively with a long-term recurrence rate of 57% compared with 63% for those treated nonoperatively for the SBO. The median time to recurrence was 0.1 years (range from 0.02-6 yr) for those whose SBO was managed operatively, compared with 0.7 years (range from 0.08-5 yr) for those managed nonoperatively for the SBO. The median length of stay for patients managed operatively for SBO was 12 days (range from 9-17 d) compared with 6 days (range from 2-33 d) for those managed nonoperatively.
  
  
  CONCLUSIONS
  Readmission for SBO within 50 days of a previous laparotomy represents a small percentage of all cases of SBO. They frequently follow small-bowel operations. Cases of strangulation are no more common than in general cases of SBO. Patients treated nonoperatively for SBO did not experience less favourable outcomes with respect to resolution of symptoms, length of stay, risk of recurrence and reoperation. Thus, operative intervention is not necessary in an otherwise stable patient.
authors.affiliation: Division of Colon and Rectal Surgery, Sir Mortimer B. Davis-Jewish General Hospital and McGill University, Montreal, Que.
authors.forename: George
authors.initials: G
authors.lastname: Miller
authors.forename: Jason
authors.initials: J
authors.lastname: Boman
authors.forename: Ian
authors.initials: I
authors.lastname: Shrier
authors.forename: Philip H
authors.initials: PH
authors.lastname: Gordon
mesh_terms: D015984:Causality; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D007421:Intestine, Small; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D011184:Postoperative Period; D012008:Recurrence; D018570:Risk Assessment; D013997:Time Factors; D000267:Tissue Adhesions / Q000150:complications