Early versus late adhesiolysis for adhesive-related intestinal obstruction: a nationwide analysis of inpatient outcomes.
BACKGROUND
Classical teaching advocates watchful waiting for 2 days before operating on adhesive-related intestinal obstructions (AIOs). Our aim was to compare the clinical and cost outcomes of early versus late adhesiolysis for AIOs.


METHODS
Patients undergoing adhesiolysis for AIOs from the 2007 Nationwide Inpatient Sample were stratified to early (≤2 days from admission) vs. late (>2 days) adhesiolysis. The primary outcome was in-hospital mortality and secondary outcomes were post-operative complications (POCs), post-operative length of stay (PLOS), and in-hospital cost.


RESULTS
From 5,443 patients who underwent adhesiolysis for AIOs, 53 and 47 % underwent early and late adhesiolysis, respectively. Late adhesiolysis patients were older (65.0 vs. 60.1 years) and more co-morbid compared to the early group (p < 0.05). After adjustment with propensity score methods, late adhesiolysis patients had no difference in mortality (odds ratio [OR] 0.95, 95%-confidence intervals [CI] 0.67-1.36, p = 0.79) or POCs (OR 1.01, 95%CI 0.89-1.14, p = 0.91) compared to the early group, but had 9.8 % increased PLOS and 41.9 % increased in-hospital cost (p < 0.001).


CONCLUSIONS
The 2-day limit of watchful waiting is not associated with increased mortality or POCs for those patients undergoing adhesiolysis for an AIO. Late adhesiolysis, however, was associated with significantly increased PLOS and in-hospital cost compared to early adhesiolysis.
Department of Surgery, Boston University Medical Center, Boston, MA, USA. danielchumd@gmail.com
Daniel I
DI
Chu
Melanie L
ML
Gainsbury
Lauren A
LA
Howard
Arthur F
AF
Stucchi
James M
JM
Becker
D000368:Aged; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007297:Inpatients; D007410:Intestinal Diseases / Q000150:complications / Q000601:surgery; D007415:Intestinal Obstruction / Q000191:economics / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D000267:Tissue Adhesions / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome; D014481:United States