title: How many sunsets? Timing of surgery in adhesive small bowel obstruction: a study of the Nationwide Inpatient Sample.
abstract: BACKGROUND
  Best practices promulgated by the Eastern Association for the Surgery of Trauma suggest that delay in surgery for adhesive small bowel obstruction (ASBO) should not exceed 5 days. This study aimed to probe the relationship between operative delay and adverse outcomes, defined as occurrence of a complication, requirement for bowel resection, prolonged postoperative stay, or death in ASBO using the Nationwide Inpatient Sample.
  
  
  METHODS
  We used the Nationwide Inpatient Sample for 2009. The relationship among days to surgery (preoperative days) and defined as occurrence of a defined set of complications, death during hospitalization, resection, and postoperative length of stay greater than 7 days (postoperative days > 7) was assessed, taking into account potential confounding factors using regression analysis.
  
  
  RESULTS
  A total of 27,046 patients were identified with small bowel obstruction; 4,826 (18%) of these required surgery, and the remainder did not, staying a mean of 4 days (median, 3 days). Of the surgical group, 1,208 patients (25.0%) had Rsx, 1,527 (32%) had postoperative days of greater than 7, 138 (2.86%) died, 3,216 (66.7%) were female. Mean age was 62.2 years, mean total length of stay was 8.51 days, mean preoperative days was 1.94 days. Odds ratio (OR) of death for operated patients was 1.64 (95% confidence interval [CI], 1.11-2.19) when preoperative days was 4 or more. Postoperative days of greater than 7 was more likely if surgery preoperative days were 4 or more (OR, 1.26; 95% CIs, 1.07-1.48). No relationship between complication and preoperative days was observed.
  
  
  CONCLUSIONS
  Delay in management of small bowel obstruction is associated with death and longer postoperative stays. Delay was not associated with complication or bowel resection. These data lend support to a policy encouraging observation of ASBO for no more than 5 days.
  
  
  METHODS
  Epidemiologic study, level III; therapeutic study, level IV.
authors.affiliation: Department of Surgery, Newton Wellesley Hospital, Newton, MA, USA.
authors.forename: Dean
authors.initials: D
authors.lastname: Schraufnagel
authors.forename: Sean
authors.initials: S
authors.lastname: Rajaee
authors.forename: Frederick Heaton
authors.initials: FH
authors.lastname: Millham
mesh_terms: D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D061665:Time-to-Treatment; D000267:Tissue Adhesions / Q000150:complications