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Master of Public Health

Impact of Operative Management on Recurrence of Adhesive Small Bowel Obstruction: A Longitudinal Analysis of a Statewide Database

AUTHORS

Medvecz AJ , Dennis BM , Wang FL , Lindsell CJ , Guillamondegui OD , . Journal of the American College of Surgeons. 2020 1 16; ().

ABSTRACT

BACKGROUND: Recurrence of adhesive small bowel obstruction (ASBO) can lead to multiple admissions. There is limited knowledge of the role of operative and non-operative treatment in the long-term recurrence risk for ASBO. We sought to determine the effect of operative and non-operative management on future ASBO recurrences.

METHODS: This is a retrospective study of administrative discharge data from the Tennessee Hospital Association. Adult discharges from 2007 to 2009 with ASBO and all subsequent readmissions within any hospital in the state were included; patients with prior ASBO from 2003 to 2007 and out-of-state residents were excluded. ASBO recurrence was compared between operative and non-operative approaches using the Andersen-Gill approach for modeling recurrent time-to-event data. Secondary outcomes included mortality, complications, and time-to-recurrence.

RESULTS: 6,191 records were analyzed, 30.0% were initially treated operatively. Patients initially managed surgically had lower overall recurrence (19.0% vs. 25.6%, p<0.005). The hazard for recurrence was lower if the most recent ASBO management was operative (HR 0.27, 95% CI, 0.23-0.31). The risk of ASBO recurrence increased with more cumulative operative or non-operative ASBO admissions relative to patients with fewer prior admissions (operative: HR 2.30, 95% CI, 2.04-2.60; non-operative: HR 1.18, 95% CI, 1.16-1.20). In-hospital mortality (3.7% vs. 2.6%, p=0.025) and time-to-recurrence (729 vs. 550 days, p=0.009) were greater in the operative group.

CONCLUSION: Operative management for the most recent ASBO is associated with fewer recurrences. Subsequent cumulative recurrences of ASBO predispose to recurrence regardless of operative or non-operative management. When considering ASBO management ASBO, subsequent recurrences should be considered.

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