TY - JOUR
T1 - Management of adhesive small bowel obstruction
T2 - A distinct paradigm shift in the United States
AU - Matsushima, Kazuhide
AU - Sabour, Andrew
AU - Park, Caroline
AU - Strumwasser, Aaron
AU - Inaba, Kenji
AU - Demetriades, Demetrios
PY - 2019/3/1
Y1 - 2019/3/1
N2 - BACKGROUND Recent studies show that early operative intervention in patients who fail nonoperative management of adhesive small bowel obstruction (ASBO) is associated with improved outcomes. The purpose of this study was to determine the trend in practice pattern and outcomes of patients with ASBO in the United States. METHODS Data from the National Inpatient Sample data (2003-2013) were extracted for analysis and included patients (age ≥18 years) who were discharged with primary diagnosis codes consistent with ASBO. We analyzed the data to examine changes in mortality and hospital length of stay in addition to any trends in rate and timing of operative interventions. RESULTS During the study period, 1,930,289 patients were identified with the diagnosis of ASBO. Over the course of the study period, the rate of operative intervention declined (46.10-42.07%, p = 0.003), and the timing between admission and operative intervention was significantly shortened (3.09-2.49 days, p < 0.001). In addition, in-hospital mortality rate decreased significantly (5.29-3.77%, p < 0.001). In the multiple logistic regression analysis, the relative risk of mortality decreased by 5.6% per year (odds ratio, 0.944; 95% confidence interval, 0.937-0.951; p < 0.001). Hospital length of stay decreased from 10.39 to 9.06 days (p < 0.001). CONCLUSION Over the last decade, fewer patients with ASBO were managed operatively, whereas those requiring an operation underwent one earlier in their hospitalization. Although further studies are warranted, our results suggest that recent changes in practice pattern may have contributed to improved outcomes. LEVEL OF EVIDENCE Therapeutic study, level IV.
AB - BACKGROUND Recent studies show that early operative intervention in patients who fail nonoperative management of adhesive small bowel obstruction (ASBO) is associated with improved outcomes. The purpose of this study was to determine the trend in practice pattern and outcomes of patients with ASBO in the United States. METHODS Data from the National Inpatient Sample data (2003-2013) were extracted for analysis and included patients (age ≥18 years) who were discharged with primary diagnosis codes consistent with ASBO. We analyzed the data to examine changes in mortality and hospital length of stay in addition to any trends in rate and timing of operative interventions. RESULTS During the study period, 1,930,289 patients were identified with the diagnosis of ASBO. Over the course of the study period, the rate of operative intervention declined (46.10-42.07%, p = 0.003), and the timing between admission and operative intervention was significantly shortened (3.09-2.49 days, p < 0.001). In addition, in-hospital mortality rate decreased significantly (5.29-3.77%, p < 0.001). In the multiple logistic regression analysis, the relative risk of mortality decreased by 5.6% per year (odds ratio, 0.944; 95% confidence interval, 0.937-0.951; p < 0.001). Hospital length of stay decreased from 10.39 to 9.06 days (p < 0.001). CONCLUSION Over the last decade, fewer patients with ASBO were managed operatively, whereas those requiring an operation underwent one earlier in their hospitalization. Although further studies are warranted, our results suggest that recent changes in practice pattern may have contributed to improved outcomes. LEVEL OF EVIDENCE Therapeutic study, level IV.
KW - Adhesive small bowel obstruction
KW - management
KW - outcome
KW - trends
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U2 - 10.1097/TA.0000000000002150
DO - 10.1097/TA.0000000000002150
M3 - Article
C2 - 30489509
AN - SCOPUS:85061959797
SN - 2163-0755
VL - 86
SP - 383
EP - 391
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 3
ER -