Trials of nonoperative management exceeding 3 days are associated with increased morbidity in patients undergoing surgery for uncomplicated adhesive small bowel obstruction.
BACKGROUND
Controversy exists over how long trials of nonoperative management should be pursued in patients with uncomplicated adhesive small bowel obstructions (ASBOs) before deciding to proceed with surgery. The purpose of this study was to determine the effect of incremental delays in surgery on the 30-day postoperative outcomes of patients undergoing surgery for uncomplicated ASBO.


METHODS
American College of Surgeons National Surgical Quality Improvement Program 2005-2011 data were used to identify patients with uncomplicated ASBO in whom a trial of nonoperative management was attempted. Multivariate logistic or linear regression model was created to determine the independent association between the length of preoperative hospitalization and 30-day postoperative outcomes after adjustment for patient- and procedure-related factors.


RESULTS
A total of 9,297 patients were included in the study. The 30-day postoperative mortality and overall morbidity rates of the entire cohort were 4.4% and 29.6%, respectively. The median postoperative length of hospitalization was 7 days (interquartile range, 5-11 days). After risk adjustment, there was no association between preoperative length of hospitalization and 30-day postoperative mortality. In contrast, increased 30-day overall morbidity was observed in patients who received their operation after a preoperative length of hospitalization of 3 days compared with earlier in their hospitalization. Furthermore, an increased postoperative length of hospitalization was found in patients who were operated on after a preoperative length of hospitalization of 4 days.


CONCLUSIONS
Trials of nonoperative management for uncomplicated ASBO exceeding 3 days are associated with increased morbidity and postoperative length of hospitalization. These trials should therefore generally not extend beyond this time point.


METHODS
Therapeutic study, level IV.
From the Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Jeffrey E
JE
Keenan
Ryan S
RS
Turley
Christopher Cameron
CC
McCoy
John
J
Migaly
Mark L
ML
Shapiro
John E
JE
Scarborough
D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D007421:Intestine, Small; D007902:Length of Stay; D008297:Male; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011300:Preoperative Care / Q000379:methods* / Q000592:standards; D012189:Retrospective Studies; D013997:Time Factors; D000267:Tissue Adhesions / Q000150:complications / Q000453:epidemiology / Q000628:therapy*