title: "Right place at the right time" impacts outcomes for acute intestinal obstruction.
abstract: BACKGROUND
  The purpose of this study was to measure how the duration of nonoperative intervention for intestinal obstruction impacted patient outcomes and whether hospital characteristics influenced the timing of operative intervention.
  
  
  METHODS
  The State Inpatient Database (Florida) of the Health Care Utilization Project and the Annual Survey database of the American Hospital Association were linked from 2006 to 2011. Included were patients ≥18 years of age with a primary diagnosis of intestinal obstruction. Patient factors included age, sex, socioeconomic factors, and comorbid conditions.
  
  
  RESULTS
  A total of 116,195 patients met our inclusion criteria, and 43,079 underwent operative intervention (37.1%). Patients who required operative correction of the intestinal obstruction after the fifth day of hospitalization, compared with patients who underwent an operation on the day of admission, had increases in mortality (6.1% vs 1.8%, P < .001), complication rates (15.4% vs 4.0%, P < .001), and postoperative hospital stay (9 vs 5 days, P < .001). Patients cared for at a large teaching facility (with surgery residents) had increased odds of early operative intervention by 23% (odds ratio 1.23, [1.20-1.28]), whereas patients at low-volume hospitals had decreased odds of early intervention (odds ratio 0.88, [0.73-0.91]).
  
  
  CONCLUSIONS
  Initial nonoperative treatment in patients with uncomplicated intestinal obstruction is an important strategy, but the odds of having an adverse event increase as intestinal obstruction is delayed. Importantly, the presence of surgery residents and increasing bed size are hospital characteristics associated with earlier operative intervention, suggesting a quality benefit for care at large teaching hospitals.
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL; One:MAP Surgical Analytics Group at LUMC Surgery, Loyola University Medical Center, Maywood, IL.
authors.forename: Anai N
authors.initials: AN
authors.lastname: Kothari
authors.affiliation: Loyola Stritch School of Medicine, Loyola University Chicago, Maywood, IL.
authors.forename: Jordan L
authors.initials: JL
authors.lastname: Liles
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL.
authors.forename: Casey J
authors.initials: CJ
authors.lastname: Holmes
authors.affiliation: One:MAP Surgical Analytics Group at LUMC Surgery, Loyola University Medical Center, Maywood, IL; Loyola Stritch School of Medicine, Loyola University Chicago, Maywood, IL.
authors.forename: Matthew A C
authors.initials: MA
authors.lastname: Zapf
authors.affiliation: One:MAP Surgical Analytics Group at LUMC Surgery, Loyola University Medical Center, Maywood, IL; Department of Urology, Loyola University Medical Center, Maywood, IL.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Blackwell
authors.affiliation: One:MAP Surgical Analytics Group at LUMC Surgery, Loyola University Medical Center, Maywood, IL; Department of Public Health Sciences, Loyola University Chicago, Maywood, IL.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kliethermes
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL; One:MAP Surgical Analytics Group at LUMC Surgery, Loyola University Medical Center, Maywood, IL.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Kuo
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL; One:MAP Surgical Analytics Group at LUMC Surgery, Loyola University Medical Center, Maywood, IL; Edward Hines Jr. Veterans Administration Medical Center, Hines, IL. Electronic address: fluchet@lumc.edu.
authors.forename: Fred A
authors.initials: FA
authors.lastname: Luchette
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005431:Florida; D006742:Hospital Bed Capacity; D017052:Hospital Mortality; D061846:Hospitals, Low-Volume; D006784:Hospitals, Teaching; D006801:Humans; D007415:Intestinal Obstruction / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D055815:Young Adult