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26-07-2023 | Small Bowel Resection | 2023 SAGES Oral

Predictive factors for operative intervention and ideal length of non-operative trial in adhesive small bowel obstruction

Authors: Tara van Veen, Purushotham Ramanathan, Lolita Ramsey, Jonathan Dort, Dina Tabello

Published in: Surgical Endoscopy | Issue 11/2023

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Abstract

Background

Small bowel obstruction (SBO) is responsible for 350,000 U.S. hospitalizations and costs ~ $2.3 billion annually. The current standard of care for SBO is to trial 3 to 5 days of non-operative management. This study evaluated the factors associated with operative management.

Methods

This retrospective cohort study included adult patients admitted with adhesive SBO. Exclusions were for operative intervention within 24 h or death.

Results

At baseline (N = 360), mean age was 65.9 years, 57.8% female, 72.3% white, mean BMI 26.1, 38.7% with history of SBO and 98.1% had history of abdominal surgery. Symptom onset prior to hospitalization was 1–2 days. 55.6% had successful non-operative management at discharge (median length of stay 3 days) vs. 44.4% operative conversion. In univariate analyses, BMI, SBO history, surgical history, days symptom onset, vitals, abdominal pain, obstipation, acute kidney injury, and lack of small bowel feces sign on CT scan were significantly associated with operative management. In a multivariable logistic regression, after controlling all other variables, a lack of small bowel feces sign (adjusted odds ratio, aOR = 2.25, 95% CI 1.06–4.77, p = 0.04) and history of exploratory laparotomy (aOR = 0.44, 95% CI 0.21–0.90, p = 0.03) were significantly associated with operative management. Time from admission to surgery averaged 3.89 days: small bowel resection (55/160) was 4.9 days (median = 4), compared to patients without resection (3.4 days, median = 2; p = 0.00; OR = 1.2, 95% CI 1.07–1.35).

Conclusions

A lack of small bowel feces sign can be a potential indicator for operative management and should be further explored. Since the median resolution of symptoms in the non-operative management group was ~ 2 days and a 20% higher odds for bowel resection each day surgery is delayed, the conservative trial period for adhesive SBO should not exceed 3 days.

Graphical abstract

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Metadata
Title
Predictive factors for operative intervention and ideal length of non-operative trial in adhesive small bowel obstruction
Authors
Tara van Veen
Purushotham Ramanathan
Lolita Ramsey
Jonathan Dort
Dina Tabello
Publication date
26-07-2023
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 11/2023
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-023-10282-9

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