Patients Treated With Surgery for Small Bowel Obstruction Less Likely to Have Recurrence

October 21, 2005

Oct. 21, 2005 (San Francisco) — Patients hospitalized for small bowel obstruction were likely to require rehospitalization within three years and had an unexpectedly high mortality rate, according to a retrospective review of information in administrative databases. Patients treated with surgery during their initial hospitalization were found to do better than those who were treated nonoperatively.

Small bowel obstructions account for 20% of acute surgical admissions, but little is known about long-term patient outcomes after discharge. To begin to fill that gap, Marcia L. McGory, MD, resident surgeon at the University of California at Los Angeles, and colleagues culled information from the California state inpatient database, which tracks four million discharges per year and can be linked to the California death file.

The team identified 32,583 hospitalizations for small bowel obstructions in 1997. The average age of the patients was 63 years, 54% were female, and 69% were white. Only 43% had no other comorbidities, while 23% had three or more comorbidities.

Twenty-four percent of the patients were treated surgically and 76% were treated nonsurgically. Patients with more comorbidities were less likely to be treated with surgery. Twenty-four percent of the no-surgery group had three or more comorbidities compared with 18% in the surgery group.

The median length of hospital stay was five days in the no-surgery group and seven days in those treated with surgery. However, in-hospital mortality was 8% in the no-surgery group compared with 5% in the surgery-treated patients. One-year mortality was also higher in the patients treated without surgery at 25% compared with 16% mortality in the surgery-treated group.

Dr. McGory speculated that the overall high one-year mortality rate in both groups may be due to the older age of the overall population and the large number of comorbidities.

When the team broke down the surgery category into subcategories according to surgery type — lysis of adhesions only (LOA), hernia repair only, small bowel resection with hernia repair, or small bowel resection with LOA — they found that length of stay was increased in patients with the small bowel resection with LOA. In-hospital mortality and one-year mortality were higher in this group at approximately 10% and 30%, respectively. By comparison, the group with the lowest mortality rates was the hernia repair only, which had 3% in-hospital and 10% one-year mortality rates.

Time to surgery after hospitalization was also longer in this group than in the other groups, suggesting that the delay may result in poorer prognosis. When the researchers analyzed all of the surgical patients in terms of the number of days between hospitalization and surgery, they found a significant correlation with mortality (no P values were provided). The longer the delay, the higher the mortality rate.

Sixteen percent of patients treated with surgical intervention during their index hospitalization required readmission within three years compared with 20% of those treated nonsurgically ( P < .001). This was true regardless of the number of comorbidities. Median time to readmission was also significantly longer (354 days) when treated with surgery compared with nonsurgical treatment (194 days).

"Given that the median time to surgery was longest in patients undergoing small bowel resection with lysis of adhesions and this cohort also had the highest mortality, one potential clinical implication of the work is to question whether these patients would have benefited from being taken into the operating room sooner," said Dr. McGory. "This is one potentially modifiable factor in the care of patients with small bowel obstruction and should be further studied."

ACS 91st Annual Clinical Congress: Papers Session II. Presented Oct. 19, 2005.

Reviewed by Gary D. Vogin, MD


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